ICD / CRT-D indications

Combines secondary- and primary-prevention ICD criteria with CRT indications to suggest the appropriate device.

Upload a report, lab sheet or echo picture to fill this calculator automatically.

Secondary prevention

Cardiomyopathy

Cardiomyopathy (must be entered)

NYHA class (must be entered)

LVEF

QRS duration

Conditions

Tap all that apply

Device recommendation

Enter the cardiomyopathy, NYHA class, LVEF and QRS.

⚠ Cardiomyopathy type and NYHA class must be entered for a primary-prevention ICD or CRT decision.

Notes: ICD indications

ESC vs ACC/AHA

ESC

Secondary prevention
IESC 2022
Survived VF or haemodynamically unstable VT without a reversible cause, expected survival > 1 year.
Ischaemic cardiomyopathy
IESC 2022
LVEF ≤ 35%, NYHA II–III after ≥ 3 months OMT, ≥ 6 weeks post-MI.
Ischaemic, NYHA I
IIaESC 2022
LVEF ≤ 30% despite ≥ 3 months OMT.
Non-ischaemic cardiomyopathy
IIaESC 2021/2022
LVEF ≤ 35%, NYHA II–III after ≥ 3 months OMT (DANISH). Favoured by LGE on CMR, high-risk genes (LMNA, FLNC, PLN, RBM20) and age < 70.
Not recommended
IIIESC 2022
NYHA IV refractory to drugs unless a candidate for CRT, LVAD or transplant; within 40 days of MI for primary prevention.

ACC/AHA

Secondary prevention
1ACC/AHA 2017
Cardiac arrest from VF or haemodynamically unstable VT, or stable sustained VT, without a reversible cause, survival > 1 year.
Ischaemic cardiomyopathy
1ACC/AHA 2022
LVEF ≤ 35%, NYHA II–III on GDMT, ≥ 40 days post-MI and ≥ 90 days post-revascularisation.
Ischaemic, NYHA I
1ACC/AHA 2022
LVEF ≤ 30%, ≥ 40 days post-MI on GDMT (MADIT-II).
Non-ischaemic cardiomyopathy
1ACC/AHA 2022
LVEF ≤ 35%, NYHA II–III on ≥ 3 months GDMT.
Not recommended
3ACC/AHA 2017
NYHA IV on drugs who are not candidates for CRT, LVAD or transplant; survival < 1 year.

Note: CRT-D

CRT-D when both indications are met
IESC 2022 · ACC/AHA 2022
CRT indication (LVEF ≤ 35%, QRS ≥ 130 ms, NYHA II–IV ambulatory) plus an ICD indication → CRT-D rather than ICD alone.
Ischaemic cardiomyopathy favours CRT-D
ESC 2021
Sudden-death risk stays high after CRT; prefer CRT-D when survival > 1 year.
Consider CRT-P instead
ESC 2021
Non-ischaemic cardiomyopathy, age > 70–75, NYHA IV, frailty or major comorbidity, survival < 1 year or the patient’s choice (DANISH: no mortality benefit of ICD on top of CRT in non-ischaemic disease).

References