ICD Reimbursement

2. ICD Reimbursement

3. ICD Reimbursement

4. ICD Reimbursement

5. ICD Reimbursement

6. ICD Reimbursement

7. ICD Reimbursement

8. ICD Reimbursement

9. Mortality by Intention-to-Treat Mortality 36.1% 7.2% year Months of follow-up

10. Mortality Months of follow-up Mortality by Intention-to-Treat

11. Mortality Months of follow-up Mortality by Intention-to-Treat

17. DEFINITE Mortality – NYHA FC III 1.0 STD=16/49 (33%) ICD= 6/47 (13%) .9 ICD .8 Probability of Survival .7 Standard .6 p=0.009; RR=0.33 .5 0 1 2 3 4 5 Survival Time in Years No. at Risk Standard 35 18 8 3 ICD 38 23 11 3

22. ICD Workup • LVEF ≤ 35% • NYHA FC • QRS Duration (120 ms) • Ischemic or nonischemic Cardiomyopathy • Duration of NIDCM • (3 vs 9 months) • Time since last Myocardial Infarction • 40 days • Time since last PCI or CABG • 3 months

23. ICD Workup • Echo • 40 days from MI • 3 months from PCI or CABG • Dyssynchrony if QRS < 120 ms • NYHA FC • On Beta Blockers & ACE Inibitor • QRS Duration (120 ms) • No ongoing need for revascularization

24. Scheduling ICD Implant • After CABG or PCI • 3 month return, D/C on Beta Blocker & ACE • 2D echo, ECG • EP consult • ICD or BiV ICD prescheduled • Determined by NYHA and FC • After MI • 40 day return , D/C on Beta Blocker & ACE • 2D echo, ECG • EP consult • ICD or BiV ICD prescheduled • Determined by NYHA and FC

25. Scheduling ICD Implant • After NIDCM Diagnosis – plan IRB Trial • 3 month return, D/C on Beta Blocker & ACE • 2D echo, ECG • EP consult • ICD or BiV ICD prescheduled • Determined by NYHA and FC • After NIDCM Diagnosis – No planned IRB Trial • 9 month return, D/C on Beta Blocker & ACE • 2D echo, ECG • EP consult • ICD or BiV ICD prescheduled • Determined by NYHA and FC