Sudden cardiac death other diagnostic studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Edzel Lorraine Co, DMD, MD[3]

Overview

There are several other diagnostic tests being done for sudden cardiac death. These include the signal-averaged electrocardiogram (SaECG), exercise testing, provocative diagnostic tests such as the sodium channel blocker testing, adenosine test, and epinephrine test, electrophysiology study, and genetic testing.

Other Diagnostic Studies

There are several other diagnostic tests being done for sudden cardiac death. These include the signal-averaged electrocardiogram (SaECG), exercise testing, provocative diagnostic tests such as the sodium channel blocker testing, adenosine test, and epinephrine test, electrophysiology study, and genetic testing [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [6] [15] [16] [17].

Signal-averaged Electrocardiogram

Exercise Testing

Provocative Diagnostic Tests

Electrophysiology Study

Genetic testing


2022 ESC Guidelines for the management of patients with ventricular arrythymias and the prevention of sudden cardiac death [24]

Recommendations for genetic testing
Class I (Level of Evidence: B)
Class I (Level of Evidence: C)
  • When a putative causative variant is first identified evaluation for pathogenicity is recommended using an internationally accepted framework.
Class I (Level of Evidence: C)
Class I (Level of Evidence: C)
Class I (Level of Evidence: C)
  • It is recommended that class III (variants of uncertain significance) and Class IV variants should be evaluated for segregation in families where possible, and the variant re-evaluated periodically.
Class III (Level of Evidence: C)
Recommendations for public basic life support and access to automated external defibrillators
Class I (Level of Evidence: B)
Class I (Level of Evidence: B)
  • Prompt CPR by bystanders is recommended at out-of-hospital cardiac arrest.
Class I (Level of Evidence: B)
Class IIa (Level of Evidence: B)
  • Mobile phone-based alerting of basic life support-trained bystander volunteers to assist nearby out-of-hospital cardiac arrest victims should be considered.
Recommendations for diagnostic evaluation and general recommendations for ventricular arrhythmia in dilated cardiomyopathy/ hypo kinetic non-dilated cardiomyopathy
Class I (Level of Evidence: B)
Class IIa (Level of Evidence: C)
Class III (Level of Evidence: C)
Recommendations for diagnosis of ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy
Class I (Level of Evidence: B)
Class I (Level of Evidence: B)
Class IIb (Level of Evidence: C)
Recommendations for diagnosis of ventricular arrhythmias in hypertrophic cardiomyopathy
Class I (Level of Evidence: B)
Class IIb (Level of Evidence: C)

2017AHA/ACC/HRS Guideline for management of sudden cardiac arrest and ventricular arrhythmia

[25]

Class I, Level of evidence: B
In patients who recovered from SCA due to ventricular arrhythmia suspected ischemic heart disease, coronary angiography and probabley revascularization is recommmended
Class I, Level of evidence:C
In patients with anomalous origin of a coronary artery leading ventricular arrhythmia or SCA, repair or revascularization is recommended
Class IIa, Level of evidence: B
In patients with ischemic or nonischemic cardiomyopathy or congenital heart disease presented with syncope arrhythmia and do not meet criteria for primary prevention ICD, an electrophysiological study is recommended for assessing the risk of sustained VT
Class III, Level of evidence: B
In patients who meet criteria for ICD implantation, an electrophysiological study is not recommended for only inducing ventricular arrhythmia
Class III, Level of evidence: B
An electrophysiological study is not recommended for risk stratification for ventricular arrhythmia in patients with Long QT syndrome, short QT syndrome, cathecolaminergic polymorphic ventricular arrhythmia




Class I (Level of Evidence: C)
  • In patients with SCA or SCD in their family member, genetic tests and genetic counselling is recommended

References

  1. ↑ Goldberger JJ, Cain ME, Hohnloser SH, Kadish AH, Knight BP, Lauer MS; et al. (2008). "American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society scientific statement on noninvasive risk stratification techniques for identifying patients at risk for sudden cardiac death: a scientific statement from the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention". Circulation. 118 (14): 1497–1518. PMID 18833586.
  2. ↑ 2.0 2.1 Gatzoulis KA, Arsenos P, Trachanas K, Dilaveris P, Antoniou C, Tsiachris D; et al. (2018). "Signal-averaged electrocardiography: Past, present, and future". J Arrhythm. 34 (3): 222–229. doi:10.1002/joa3.12062. PMC 6010001. PMID 29951136.
  3. ↑ 3.0 3.1 Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA; et al. (2010). "Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the Task Force Criteria". Eur Heart J. 31 (7): 806–14. doi:10.1093/eurheartj/ehq025. PMC 2848326. PMID 20172912.
  4. ↑ 4.0 4.1 Giudicessi JR, Ackerman MJ (2019). "Exercise testing oversights underlie missed and delayed diagnosis of catecholaminergic polymorphic ventricular tachycardia in young sudden cardiac arrest survivors". Heart Rhythm. 16 (8): 1232–1239. doi:10.1016/j.hrthm.2019.02.012. PMID 30763784.
  5. ↑ 5.0 5.1 Roston TM, Kallas D, Davies B, Franciosi S, De Souza AM, Laksman ZW; et al. (2021). "Burst Exercise Testing Can Unmask Arrhythmias in Patients With Incompletely Penetrant Catecholaminergic Polymorphic Ventricular Tachycardia". JACC Clin Electrophysiol. 7 (4): 437–441. doi:10.1016/j.jacep.2021.02.013. PMID 33888264 Check |pmid= value (help).
  6. ↑ 6.0 6.1 6.2 Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C; et al. (2013). "Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes". Europace. 15 (10): 1389–406. doi:10.1093/europace/eut272. PMID 23994779.
  7. ↑ 7.0 7.1 Govindan M, Batchvarov VN, Raju H, Shanmugam N, Bizrah M, Bastiaenen R; et al. (2010). "Utility of high and standard right precordial leads during ajmaline testing for the diagnosis of Brugada syndrome". Heart. 96 (23): 1904–8. doi:10.1136/hrt.2010.201244. PMID 20962343.
  8. ↑ Churet M, Luttoo K, Hocini M, Haïssaguerre M, Sacher F, Duchateau J (2019). "Diagnostic reproducibility of epinephrine drug challenge interpretation in suspected long QT syndrome". J Cardiovasc Electrophysiol. 30 (6): 896–901. doi:10.1111/jce.13926. PMID 30907461.
  9. ↑ 9.0 9.1 Bourke JP, Richards DA, Ross DL, Wallace EM, McGuire MA, Uther JB (1991). "Routine programmed electrical stimulation in survivors of acute myocardial infarction for prediction of spontaneous ventricular tachyarrhythmias during follow-up: results, optimal stimulation protocol and cost-effective screening". J Am Coll Cardiol. 18 (3): 780–8. doi:10.1016/0735-1097(91)90802-g. PMID 1907984.
  10. ↑ 10.0 10.1 Gatzoulis KA, Tsiachris D, Arsenos P, Archontakis S, Dilaveris P, Vouliotis A; et al. (2014). "Prognostic value of programmed ventricular stimulation for sudden death in selected high risk patients with structural heart disease and preserved systolic function". Int J Cardiol. 176 (3): 1449–51. doi:10.1016/j.ijcard.2014.08.068. PMID 25150471.
  11. ↑ 11.0 11.1 Gatzoulis KA, Vouliotis AI, Tsiachris D, Salourou M, Archontakis S, Dilaveris P; et al. (2013). "Primary prevention of sudden cardiac death in a nonischemic dilated cardiomyopathy population: reappraisal of the role of programmed ventricular stimulation". Circ Arrhythm Electrophysiol. 6 (3): 504–12. doi:10.1161/CIRCEP.113.000216. PMID 23588627.
  12. ↑ 12.0 12.1 Brilakis ES, Shen WK, Hammill SC, Hodge DO, Rea RF, Lexvold NY; et al. (2001). "Role of programmed ventricular stimulation and implantable cardioverter defibrillators in patients with idiopathic dilated cardiomyopathy and syncope". Pacing Clin Electrophysiol. 24 (11): 1623–30. doi:10.1046/j.1460-9592.2001.01623.x. PMID 11816631.
  13. ↑ 13.0 13.1 Brembilla-Perrot B, Suty-Selton C, Beurrier D, Houriez P, Nippert M, de la Chaise AT; et al. (2004). "Differences in mechanisms and outcomes of syncope in patients with coronary disease or idiopathic left ventricular dysfunction as assessed by electrophysiologic testing". J Am Coll Cardiol. 44 (3): 594–601. doi:10.1016/j.jacc.2004.03.075. PMID 15358027.
  14. ↑ 14.0 14.1 Schmitt C, Barthel P, Ndrepepa G, Schreieck J, Plewan A, Schömig A; et al. (2001). "Value of programmed ventricular stimulation for prophylactic internal cardioverter-defibrillator implantation in postinfarction patients preselected by noninvasive risk stratifiers". J Am Coll Cardiol. 37 (7): 1901–7. doi:10.1016/s0735-1097(01)01246-3. PMID 11401129.
  15. ↑ Ingles J, Lind JM, Phongsavan P, Semsarian C (2008). "Psychosocial impact of specialized cardiac genetic clinics for hypertrophic cardiomyopathy". Genet Med. 10 (2): 117–20. doi:10.1097/GIM.0b013e3181612cc7. PMID 18281919.
  16. ↑ Ackerman MJ, Priori SG, Willems S, Berul C, Brugada R, Calkins H; et al. (2011). "HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies this document was developed as a partnership between the Heart Rhythm Society (HRS) and the European Heart Rhythm Association (EHRA)". Heart Rhythm. 8 (8): 1308–39. doi:10.1016/j.hrthm.2011.05.020. PMID 21787999.
  17. ↑ Conte G, Wilde A, Behr ER, Scherr D, Lenarczyk R, Gandjbachkh E; et al. (2021). "Importance of Dedicated Units for the Management of Patients With Inherited Arrhythmia Syndromes". Circ Genom Precis Med. 14 (2): e003313. doi:10.1161/CIRCGEN.120.003313. PMC 8284353 Check |pmc= value (help). PMID 33797288 Check |pmid= value (help).
  18. ↑ James CA, Jongbloed JDH, Hershberger RE, Morales A, Judge DP, Syrris P; et al. (2021). "International Evidence Based Reappraisal of Genes Associated With Arrhythmogenic Right Ventricular Cardiomyopathy Using the Clinical Genome Resource Framework". Circ Genom Precis Med. 14 (3): e003273. doi:10.1161/CIRCGEN.120.003273. PMC 8205996 Check |pmc= value (help). PMID 33831308 Check |pmid= value (help).
  19. ↑ Lahrouchi N, Tadros R, Crotti L, Mizusawa Y, Postema PG, Beekman L; et al. (2020). "Transethnic Genome-Wide Association Study Provides Insights in the Genetic Architecture and Heritability of Long QT Syndrome". Circulation. 142 (4): 324–338. doi:10.1161/CIRCULATIONAHA.120.045956. PMC 7382531 Check |pmc= value (help). PMID 32429735 Check |pmid= value (help).
  20. ↑ Wijeyeratne YD, Tanck MW, Mizusawa Y, Batchvarov V, Barc J, Crotti L; et al. (2020). "SCN5A Mutation Type and a Genetic Risk Score Associate Variably With Brugada Syndrome Phenotype in SCN5A Families". Circ Genom Precis Med. 13 (6): e002911. doi:10.1161/CIRCGEN.120.002911. PMC 7748043 Check |pmc= value (help). PMID 33164571 Check |pmid= value (help).
  21. ↑ Harper AR, Goel A, Grace C, Thomson KL, Petersen SE, Xu X; et al. (2021). "Common genetic variants and modifiable risk factors underpin hypertrophic cardiomyopathy susceptibility and expressivity". Nat Genet. 53 (2): 135–142. doi:10.1038/s41588-020-00764-0. PMC 8240954 Check |pmc= value (help). PMID 33495597 Check |pmid= value (help).
  22. ↑ Tadros R, Francis C, Xu X, Vermeer AMC, Harper AR, Huurman R; et al. (2021). "Shared genetic pathways contribute to risk of hypertrophic and dilated cardiomyopathies with opposite directions of effect". Nat Genet. 53 (2): 128–134. doi:10.1038/s41588-020-00762-2. PMC 7611259 Check |pmc= value (help). PMID 33495596 Check |pmid= value (help).
  23. ↑ Tadros R, Tan HL, ESCAPE-NET Investigators. El Mathari S, Kors JA, Postema PG; et al. (2019). "Predicting cardiac electrical response to sodium-channel blockade and Brugada syndrome using polygenic risk scores". Eur Heart J. 40 (37): 3097–3107. doi:10.1093/eurheartj/ehz435. PMC 6769824 Check |pmc= value (help). PMID 31504448.
  24. ↑ Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA; et al. (2022). "2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death". Eur Heart J. 43 (40): 3997–4126. doi:10.1093/eurheartj/ehac262. PMID 36017572 Check |pmid= value (help).
  25. ↑ Al-Khatib, Sana M.; Stevenson, William G.; Ackerman, Michael J.; Bryant, William J.; Callans, David J.; Curtis, Anne B.; Deal, Barbara J.; Dickfeld, Timm; Field, Michael E.; Fonarow, Gregg C.; Gillis, Anne M.; Granger, Christopher B.; Hammill, Stephen C.; Hlatky, Mark A.; Joglar, José A.; Kay, G. Neal; Matlock, Daniel D.; Myerburg, Robert J.; Page, Richard L. (2018). "2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death". Circulation. 138 (13). doi:10.1161/CIR.0000000000000549. ISSN 0009-7322.

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