A guideline has been published by the American College of Cardiology Foundation (ACCF), American Heart Association (AHA), and Heart Rhythm Society (HRS) regarding ‘off-label’ use of implantable cardioverter-defibrillators (ICDs). Some patients who are not included or well represented in clinical trials and who, therefore, are not technically covered by formal practice guidelines may benefit from the devices:
Patients with Abnormal Troponin Unrelated to a Myocardial Infarction (MI)
Small troponin leaks sometimes occur in the context of demand ischemia (e.g., tachyarrhythmia, congestive heart failure, pulmonary embolism) or other conditions (renal failure, myocarditis) that are thought to be unrelated to MI. ICD implantation is only recommended in presence of standard primary- or secondary-prevention criteria.