Congestive heart failure sudden cardiac death prevention

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Medical Therapy:

Summary
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Chronic Pharmacotherapy in HFrEF
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Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
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ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

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Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT) [1]

Recommendations for Heart Failure

Class I
"1. ICD therapy is recommended for secondary prevention of SCD in patients who survived VF or hemodynamically unstable VT, or VT with syncope and who have an LVEF less than or equal to 40%, who are receiving chronic optimal medical therapy, and who have a reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: A) "
"2. ICD therapy is recommended for primary prevention to reduce total mortality by a reduction in SCD in patients with LV dysfunction due to prior MI who are at least 40 d post-MI, have an LVEF less than or equal to 30% to 40%, are NYHA functional class II or III receiving chronic optimal medical therapy, and who have reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: A) "
"3. ICD therapy is recommended for primary prevention to reduce total mortality by a reduction in SCD in patients with nonischemic heart disease who have an LVEF less than or equal to 30% to 35%, are NYHA functional class II or III, are receiving chronic optimal medical therapy, and who have reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: B) "
"4. Amiodarone, sotalol, and/or other beta blockers are recommended pharmacological adjuncts to ICD therapy to suppress symptomatic ventricular tachyarrhythmias (both sustained and nonsustained) in otherwise optimally treated patients with HF. (Level of Evidence: C)"
"5. Amiodarone is indicated for the suppression of acute hemodynamically compromising ventricular or supraventricular tachyarrhythmias when cardioversion and/or correction of reversible causes have failed to terminate the arrhythmia or prevent its early recurrence. (Level of Evidence: B)"
Class IIa
"1. ICD therapy combined with biventricular pacing can be effective for primary prevention to reduce total mortality by a reduction in SCD in patients with NYHA functional class III or IV, are receiving optimal medical therapy, in sinus rhythm with a QRS complex of at least 120 ms, and who have reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: B)"
"2. ICD therapy is reasonable for primary prevention to reduce total mortality by a reduction in SCD in patients with LV dysfunction due to prior MI who are at least 40 d post-MI, have an LVEF of less than or equal to 30% to 35%, are NYHA functional class I,are receiving chronic optimal medical therapy, and have reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: B) "
"3. ICD therapy is reasonable in patients who have recurrent stable VT, a normal or near normal LVEF, and optimally treated HF and who have a reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: C)"
"4. Biventricular pacing in the absence of ICD therapy is reasonable for the prevention of SCD in patients with NYHA functional class III or IV HF, an LVEF less than or equal to 35%, and a QRS complex equal to or wider than 160 ms (or at least 120 ms in the presence of other evidence of ventricular dyssynchrony) who are receiving chronic optimal medical therapy and who have reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: B)"
Class IIb
"1. Amiodarone, sotalol, and/or beta blockers may be considered as pharmacological alternatives to ICD therapy to suppress symptomatic ventricular tachyarrhythmias (both sustained and nonsustained) in optimally treated patients with HF for whom ICD therapy is not feasible. (Level of Evidence: C)"
"2. ICD therapy may be considered for primary prevention to reduce total mortality by a reduction in SCD in patients with nonischemic heart disease who have an LVEF of less than or equal to 30% to 35%, are NYHA functional class I receiving chronic optimal medical therapy, and who have a reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: B) "

References

  1. Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M; et al. (2006). "ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation. 114 (10): e385–484. doi:10.1161/CIRCULATIONAHA.106.178233. PMID 16935995.

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