DETECT ICD Algorithm (Syncope Work-up)

DETECT ICD algorithm — explanation and clinical context The DETECT ICD tool is a pragmatic, rule-based decision support algorithm to help clinicians triage patients with syncope who may require consideration of implantable cardioverter-defibrillator (ICD) therapy or expedited electrophysiology evaluation. It prioritizes: (1) clear secondary-prevention indications such as documented sustained ventricular tachycardia (VT) or cardiac arrest; (2) guideline thresholds for primary prevention (for example structural heart disease with reduced LVEF ≤35% after optimization of medical therapy); and (3) aggregation of high-risk clinical features — abnormal ECG, syncope during exertion or without prodrome, family history of sudden cardiac death, and inducible ventricular arrhythmia on EPS — to identify intermediate and high-risk cases. For patients without high-risk features, the recommended pathway emphasizes targeted diagnostic testing (orthostatic vitals, ECG, ambulatory monitoring or implantable loop recorder, tilt-testing when reflex syncope suspected) and specialist referral when features are concerning.

This approach is aligned with contemporary syncope guidelines and validated risk frameworks used for short-term outcome prediction in emergency settings.