Perspective:

The following are 10 selected points to remember from this document:

1. In the setting of coronary artery disease (CAD), ventricular fibrillation (VF) during the first 2 days of a myocardial infarction (MI) rarely is an appropriate indication for an implantable cardioverter-defibrillator (ICD) if the ejection fraction (EF) is >35% and there has been total revascularization.

2. If the CAD is not amenable to revascularization, an ICD is appropriate for VF during an acute MI when the EF is ≤35%, and may be appropriate when the EF is >35%.

3. An ICD is appropriate after cardiac arrest in patients with EF <50% and CAD who underwent complete revascularization post-arrest.

4. An ICD is appropriate for first-degree relatives of a patient with idiopathic VF.

5. An ICD is rarely appropriate for patients with cardiac arrest, Wolff-Parkinson-White syndrome, successful accessory pathway ablation, and a structurally normal heart.

6. In CAD patients with unexplained syncope, prior MI, and EF ≤35%, an ICD is appropriate whether or not an electrophysiology study is performed.

7. In CAD patients with prior MI, an ICD is appropriate after an episode of sustained hemodynamically stable VT, regardless of EF.

8. An ICD is appropriate after successful ablation of bundle branch reentry in patients with nonischemic cardiomyopathy and an EF <50%.

9. Replacement of a cardiac resynchronization therapy (CRT)-ICD implanted when the EF was ≤35% with another CRT-ICD is appropriate regardless of the EF at the time of battery depletion.

10. In patients with a narrow QRS, an EF ≤35%, and a clinical indication for an ICD, a CRT-ICD is appropriate when ventricular pacing is anticipated to be >40%.