Ventricular tachycardia secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in Chief: Sara Zand, M.D.[2] Avirup Guha, M.B.B.S.[3]

Overview

Secondary prevention

Secondary prevention strategies following SCA and unstable VT include ICD implantation, and medications.

Secondary prevention in patients with ischemic heart disease

Recommendations for secondary prevention of sudden cardiac death in ischemic heart disease
ICD implantation (Class I, Level of Evidence B):

❑ In patients with IHD and survivors of SCD due to VT, VF or hermodynamically unstable VT or incessant VT with irreversible cause, ICD should be implanted if survival is more than 1 year.

ICD implantation (Intermediate value statement, Level of Evidence B) :

❑ In patients with higher risk of death due to ventricular arrhythmia and lower risk of non cardiac death due to other comorbidities, ICD implantation has intermediate value.

ICD implantation : (Class I, Level of Evidence B)

❑ In patients with IHD and unexplained syncope with induction of sustained monomorphic VT in EPS, ICD implantation is recommended if life expectancy is more than 1 year

Abbreviations: VT: Ventricular tachycardia; VF: Ventricular fibrillation; ICD: Implantable cardioverter defibrillator

The above table adopted from 2017 AHA/ACC/HRS Guideline




 
 
 
 
 
 
Secondary prevention in patients with IHD
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
SCA survivor or sustained monomorph VT
 
 
 
Cardiac syncope
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ischemia
 
 
 
LVEF≤35%
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes: revascularization, reassessment about SCD risk (class1)
 
NO:ICD candidate
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes:ICD (class1)
 
NO: medical therapy (class1)
 
 
Yes:ICD (CLASS1)
 
NO:EP study (class 2a)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ventriculat arrhythmia induction
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes: ICD (class1)
 
NO: monitoring
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The above algorithm adopted from 2017 AHA/ACC/HRS Guideline

Secondary prevention in patients with coronary spasm


Recommendations for secondary prevention of sudden cardiac death in coronary spasm
ICD implantation (Class I, Level of Evidence B):

❑ In patients with ventricular arrhythmia due to coronary artery spasm, vasodilator such as calcium channel blocker with maximum tolerated doses smoking cessation and is recommended

ICD implantation (Class IIa, Level of Evidence B) :

❑ In survival of SCA due to coronary artery spasm with ineffective or not tolerated medications, ICD implantation is recommended if the survival is more than 1 year

ICD implantation : (Class IIb, Level of Evidence B)

❑ In survival of SCA due to coronary artery spasm, ICD implantation in addition to medical therapy is recommended if life expectancy is more than 1 year

Abbreviations: ICD: Implantable cardioverter defibrillator; SCA: Sudden cardiac arrest

The above table adopted from 2017 AHA/ACC/HRS Guideline

Post CABG,VT/VF

Secondary prevention in non-ischemic cardiomyopathy

Recommendations for secondary prevention of sudden cardiac death in non-ischemic cardiomyopathy
ICD implantation (Class I, Level of Evidence B):

ICD implantation is recommended in survivors of SCA or thermodynamically unstable VT or sustained VT , not related to reversible causes if life expectancy is more than 1 year

ICD implantation, EPS study (Class IIa, Level of Evidence B) :

❑ In the presence of syncopre presumed due to ventricular arrhythmia, ICD or EPS study for risk stratification of SCD is recommended if survival is more than 1 year

Amiodarone : (Class IIb, Level of Evidence B)

❑ In survival of SCA, or sustained VT, or symptomatic ventricular arrhythmia who are ineligible for ICD implantation due to limited life expectancy or inaccessible venous sites, amiodarone is recommended

Abbreviations: ICD: Implantable cardioverter defibrillator; SCA: Sudden cardiac arrest; NICM Non ischemic cardiomyopathy; EPS Electrophysiology study; SCD Sudden cardiac death; VT Ventricular tachycardia

The above table adopted from 2017 AHA/ACC/HRS Guideline

References

  1. "A Comparison of Antiarrhythmic-Drug Therapy with Implantable Defibrillators in Patients Resuscitated from Near-Fatal Ventricular Arrhythmias". New England Journal of Medicine. 337 (22): 1576–1584. 1997. doi:10.1056/NEJM199711273372202. ISSN 0028-4793.
  2. Wyse, D.George; Friedman, Peter L; Brodsky, Michael A; Beckman, Karen J; Carlson, Mark D; Curtis, Anne B; Hallstrom, Alfred P; Raitt, Merritt H; Wilkoff, Bruce L; Greene, H.Leon (2001). "Life-threatening ventricular arrhythmias due to transient or correctable causes: high risk for death in follow-up". Journal of the American College of Cardiology. 38 (6): 1718–1724. doi:10.1016/S0735-1097(01)01597-2. ISSN 0735-1097.
  3. Raitt, Merritt H.; Renfroe, Ellen Graham; Epstein, Andrew E.; McAnulty, John H.; Mounsey, Paul; Steinberg, Jonathan S.; Lancaster, Scott E.; Jadonath, Ram L.; Hallstrom, Alfred P. (2001). ""Stable" Ventricular Tachycardia Is Not a Benign Rhythm". Circulation. 103 (2): 244–252. doi:10.1161/01.CIR.103.2.244. ISSN 0009-7322.
  4. Maury, P.; Baratto, F.; Zeppenfeld, K.; Klein, G.; Delacretaz, E.; Sacher, F.; Pruvot, E.; Brigadeau, F.; Rollin, A.; Andronache, M.; Maccabelli, G.; Gawrysiak, M.; Brenner, R.; Forclaz, A.; Schlaepfer, J.; Lacroix, D.; Duparc, A.; Mondoly, P.; Bouisset, F.; Delay, M.; Hocini, M.; Derval, N.; Sadoul, N.; Magnin-Poull, I.; Klug, D.; Haissaguerre, M.; Jais, P.; Della Bella, P.; De Chillou, C. (2014). "Radio-frequency ablation as primary management of well-tolerated sustained monomorphic ventricular tachycardia in patients with structural heart disease and left ventricular ejection fraction over 30%". European Heart Journal. 35 (22): 1479–1485. doi:10.1093/eurheartj/ehu040. ISSN 0195-668X.
  5. "Guidelines for diagnosis and treatment of patients with vasospastic angina (coronary spastic angina) (JCS 2008): digest version". Circ J. 74 (8): 1745–62. August 2010. doi:10.1253/circj.cj-10-74-0802. PMID 20671373.
  6. Morikawa, Yoshinobu; Mizuno, Yuji; Yasue, Hirofumi (2010). "Letter by Morikawa et al Regarding Article, "Coronary Artery Spasm: A 2009 Update"". Circulation. 121 (3). doi:10.1161/CIR.0b013e3181ce1bcc. ISSN 0009-7322.
  7. Saxon, Leslie A.; Wiener, Isaac; Natterson, Paul D.; Laks, Hillel; Drinkwater, Davis; Stevenson, William G.X. (1995). "Monomorphic versus polymorphic ventricular tachycardia after coronary artery bypass grafting". The American Journal of Cardiology. 75 (5): 403–405. doi:10.1016/S0002-9149(99)80566-9. ISSN 0002-9149.
  8. Vakil, Kairav; Florea, Viorel; Koene, Ryan; Kealhofer, Jessica Voight; Anand, Inderjit; Adabag, Selcuk (2016). "Effect of Coronary Artery Bypass Grafting on Left Ventricular Ejection Fraction in Men Eligible for Implantable Cardioverter–Defibrillator". The American Journal of Cardiology. 117 (6): 957–960. doi:10.1016/j.amjcard.2015.12.029. ISSN 0002-9149.
  9. Mittal, Suneet; Lomnitz, David J.; Mirchandani, Sunil; Stein, Kenneth M.; Markowitz, Steven M.; Slotwiner, David J.; Iwai, Sei; Das, Mithilesh K.; Lerman, Bruce B. (2002). "Prognostic Significance of Nonsustained Ventricular Tachycardia After Revascularization". Journal of Cardiovascular Electrophysiology. 13 (4): 342–346. doi:10.1046/j.1540-8167.2002.00342.x. ISSN 1045-3873.
  10. Bigger, J. Thomas (1997). "Prophylactic Use of Implanted Cardiac Defibrillators in Patients at High Risk for Ventricular Arrhythmias after Coronary-Artery Bypass Graft Surgery". New England Journal of Medicine. 337 (22): 1569–1575. doi:10.1056/NEJM199711273372201. ISSN 0028-4793.


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