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| __NOTOC__
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| {{Ventricular tachycardia}}
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| {{CMG}}; '''Associate Editor-in Chief''': {{Sara.Zand}} [[User:Avirupguha|Avirup Guha, M.B.B.S.]][mailto:avirup.guha@gmail.com]
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| ==Overview==
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| ==[[Secondary prevention]]==
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| [[Secondary prevention]] strategies following [[SCA]] and unstable [[VT]] include [[ICD]] implantation, and [[medications]].
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| * Based on meta-analysis of [[AVID trial]] implantation of [[ICD]] for [[secondary prevention]] of [[ventricular arrhythmia]] was superior to [[antiarrhythmic]] drugs in [[patients]] who survived of [[sudden cardiac arrest]] or unstable [[VT]].<ref>{{cite journal|title=A Comparison of Antiarrhythmic-Drug Therapy with Implantable Defibrillators in Patients Resuscitated from Near-Fatal Ventricular Arrhythmias|journal=New England Journal of Medicine|volume=337|issue=22|year=1997|pages=1576–1584|issn=0028-4793|doi=10.1056/NEJM199711273372202}}</ref>
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| * Before [[ICD]] implantation, the reversible causes of [[ventricular arrhythmia]] including [[myocardial ischemia]], [[electrolyte disturbance]], [[proarrhythmic]] medication effect may be corrected.<ref name="WyseFriedman2001">{{cite journal|last1=Wyse|first1=D.George|last2=Friedman|first2=Peter L|last3=Brodsky|first3=Michael A|last4=Beckman|first4=Karen J|last5=Carlson|first5=Mark D|last6=Curtis|first6=Anne B|last7=Hallstrom|first7=Alfred P|last8=Raitt|first8=Merritt H|last9=Wilkoff|first9=Bruce L|last10=Greene|first10=H.Leon|title=Life-threatening ventricular arrhythmias due to transient or correctable causes: high risk for death in follow-up|journal=Journal of the American College of Cardiology|volume=38|issue=6|year=2001|pages=1718–1724|issn=07351097|doi=10.1016/S0735-1097(01)01597-2}}</ref>
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| * [[ICD]] implantation improved outcome in well-tolerated [[VT]] and [[structurally heart disease]].<ref name="RaittRenfroe2001">{{cite journal|last1=Raitt|first1=Merritt H.|last2=Renfroe|first2=Ellen Graham|last3=Epstein|first3=Andrew E.|last4=McAnulty|first4=John H.|last5=Mounsey|first5=Paul|last6=Steinberg|first6=Jonathan S.|last7=Lancaster|first7=Scott E.|last8=Jadonath|first8=Ram L.|last9=Hallstrom|first9=Alfred P.|title=“Stable” Ventricular Tachycardia Is Not a Benign Rhythm|journal=Circulation|volume=103|issue=2|year=2001|pages=244–252|issn=0009-7322|doi=10.1161/01.CIR.103.2.244}}</ref>
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| * [[VT ablation]] reduced recurrence of [[tachyarrhythmia]], but the effect on long-term [[mortality]] was unknown.<ref name="MauryBaratto2014">{{cite journal|last1=Maury|first1=P.|last2=Baratto|first2=F.|last3=Zeppenfeld|first3=K.|last4=Klein|first4=G.|last5=Delacretaz|first5=E.|last6=Sacher|first6=F.|last7=Pruvot|first7=E.|last8=Brigadeau|first8=F.|last9=Rollin|first9=A.|last10=Andronache|first10=M.|last11=Maccabelli|first11=G.|last12=Gawrysiak|first12=M.|last13=Brenner|first13=R.|last14=Forclaz|first14=A.|last15=Schlaepfer|first15=J.|last16=Lacroix|first16=D.|last17=Duparc|first17=A.|last18=Mondoly|first18=P.|last19=Bouisset|first19=F.|last20=Delay|first20=M.|last21=Hocini|first21=M.|last22=Derval|first22=N.|last23=Sadoul|first23=N.|last24=Magnin-Poull|first24=I.|last25=Klug|first25=D.|last26=Haissaguerre|first26=M.|last27=Jais|first27=P.|last28=Della Bella|first28=P.|last29=De Chillou|first29=C.|title=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%|journal=European Heart Journal|volume=35|issue=22|year=2014|pages=1479–1485|issn=0195-668X|doi=10.1093/eurheartj/ehu040}}</ref>
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| * Among [[patients]] with [[ischemia heart disease]] and [[syncope ]] due to inducible sustained [[monomorphic VT]], [[ICD]] is recommended even if there is not other criteria for [[primary prevention]] implantation of [[ICD]].
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| ==[[Secondary prevention]] in [[patients]] with [[ischemic heart disease]]==
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| {| style="cellpadding=0; cellspacing= 0; width: 600px;"
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| | style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Recommendations for secondary prevention of sudden cardiac death in ischemic heart disease'''
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| |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | '''[[ICD]] implantation ([[ACC AHA guidelines classification scheme|Class I, Level of Evidence B]]):'''
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| |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
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| ❑ 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.
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| |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[ICD]] implantation ([[ACC AHA guidelines classification scheme|Intermediate value statement, Level of Evidence B]]) :'''
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| |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
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| ❑ 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.
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| |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[ICD implantation]] : ([[ACC AHA guidelines classification scheme|Class I, Level of Evidence B]])'''
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| |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
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| ❑ 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
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| |}
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| <span style="font-size:85%">'''Abbreviations:'''
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| '''VT:''' [[Ventricular tachycardia]];
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| '''VF:''' [[Ventricular fibrillation]];
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| '''ICD:''' [[ Implantable cardioverter defibrillator]]
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| </span>
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| <br>
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| {|
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| ! colspan="2" style="background: PapayaWhip;" align="center" + |The above table adopted from 2017 AHA/ACC/HRS Guideline
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| {{Family tree/start}}
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| {{Family tree | | | | | | | A01 | | | | A01=[[Secondary prevention]] in [[patients]] with [[IHD]]}}
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| {{Family tree | | | | |,|-|-|^|-|-|.| | }}
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| {{Family tree | | | | B01 | | | | B02 | | |B01=[[SCA]] survivor or sustained monomorph [[VT]]|B02=Cardiac [[syncope]]}}
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| {{Family tree | | | | |!| | | | | |!| | | | | | | | |}}
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| {{Family tree | | | | C01 | | | | C02 |-|-|-|.| | | | | |C01=[[Ischemia]]|C02=LVEF≤35%}}
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| {{Family tree | | |,|-|^|-|.| | | | | | | | |!| | | |}}
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| {{Family tree | | |D01| |D02| | | | | | |!| | | | | | | |D01=Yes: [[revascularization]], reassessment about [[SCD]] risk (class1)|D02=NO:[[ICD]] candidate}}
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| {{Family tree | | | | |,|-|^|-|.| | | | |,|-|^|-|.| |}}
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| {{Family tree | | | | |E01| |E02| | | D03 | | D04 | | | | E01=Yes:[[ICD]] (class1)|E02=NO: medical therapy (class1)|D03= Yes:[[ICD]] (CLASS1)| D04=NO:[[EP study]] (class 2a)}}
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| {{Family tree | | | | | | | | | | | | | | | | | |!| |}}
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| {{Family tree | | | | | | | | | | | | | | | | | E03 | |E03=[[Ventriculat arrhythmia]] induction}}
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| {{Family tree | | | | | | | | | | | | | | | |,|-|^|-|.| |}}
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| {{Family tree | | | | | | | | | | | | | | | |F01| |F02| |F01=Yes: [[ICD]] (class1)|F02=NO: monitoring }}
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| {{Family tree | | | | | | | | | | | | | | | | | | | |}}
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| {{Family tree | | | | | | | | | | | | | | | | | | | |}}
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| {{Family tree | | | | | | | | | | | | | | | | | | | |}}
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| {{Family tree | | | | | | | | | | | | | | | | | | | |}}
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| {{Family tree | | | | | | | | | | | | | | | | | | | |}}
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| {{Family tree | | | | | | | | | | | | | | | | | | | |}}
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| {{Family tree/end}}
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| {|
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| ! colspan="2" style="background: PapayaWhip;" align="center" + |The above algorithm adopted from 2017 AHA/ACC/HRS Guideline
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| |}
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| ==[[Secondary prevention ]] in [[patients]] with [[coronary spasm]]==
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| *[[Coronary artery spasm]] is due to [[vasomotor dysfunction]] and may occur in the presence or absence of [[atherosclerosis ]]process.<ref name="pmid20671373">{{cite journal |vauthors= |title=Guidelines for diagnosis and treatment of patients with vasospastic angina (coronary spastic angina) (JCS 2008): digest version |journal=Circ J |volume=74 |issue=8 |pages=1745–62 |date=August 2010 |pmid=20671373 |doi=10.1253/circj.cj-10-74-0802 |url=}}</ref>
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| * [[Vasospasm]] mat lead to [[ventricular arrhythmia]], [[syncope]], and [[sudden cardiac death]].
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| * Prevention of [[vasospasm]] may include [[smoking cessation]] and [[using]] [[dihyropyridine]] [[calcium channel blocker]] with or without [[nitrate]].
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| * In the presence of recurrent [[ventricular arrhythmia]] in spite of maximum doses of [[medications]] or survivors of [[SCA]], implantation of [[ICD]] is recommended.<ref name="MorikawaMizuno2010">{{cite journal|last1=Morikawa|first1=Yoshinobu|last2=Mizuno|first2=Yuji|last3=Yasue|first3=Hirofumi|title=Letter by Morikawa et al Regarding Article, “Coronary Artery Spasm: A 2009 Update”|journal=Circulation|volume=121|issue=3|year=2010|issn=0009-7322|doi=10.1161/CIR.0b013e3181ce1bcc}}</ref>
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| {| style="cellpadding=0; cellspacing= 0; width: 600px;"
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| | style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Recommendations for secondary prevention of sudden cardiac death in coronary spasm'''
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| |-
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| |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | '''[[ICD]] implantation ([[ACC AHA guidelines classification scheme|Class I, Level of Evidence B]]):'''
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| |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
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| ❑ 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<br>
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| |-
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| |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[ICD]] implantation ([[ACC AHA guidelines classification scheme|Class IIa, Level of Evidence B]]) :'''
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| |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
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| ❑ 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<br>
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| |-
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| |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[ICD implantation]] : ([[ACC AHA guidelines classification scheme|Class IIb, Level of Evidence B]])'''
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| |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
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| ❑ 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
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| |-
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| |}
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| <span style="font-size:85%">'''Abbreviations:'''
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| '''ICD:''' [[Implantable cardioverter defibrillator]];
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| '''SCA:''' [[Sudden cardiac arrest]]
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| </span>
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| <br>
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| {|
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| ! colspan="2" style="background: PapayaWhip;" align="center" + |The above table adopted from 2017 AHA/ACC/HRS Guideline
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| |}
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| ==Post [[CABG]],[[VT]]/[[VF]]==
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| * [[Ventricular tachycardia]] rarely occur within 24 hours after [[CABG]] due to the transient effects of [[reperfusion]], [[electrolyte]] and [[acid-base]] disturbances, and the use of [[inotrope]].
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| * [[VF]] or [[poly morphic VT]] in the postoperative period may be the manifestation of [[myocardial ischemia]] and [[mechanical complications]] and acute [[electrolyte]] or [[acid base]] disturbances and graft patency should be warranted.<ref name="SaxonWiener1995">{{cite journal|last1=Saxon|first1=Leslie A.|last2=Wiener|first2=Isaac|last3=Natterson|first3=Paul D.|last4=Laks|first4=Hillel|last5=Drinkwater|first5=Davis|last6=Stevenson|first6=William G.X.|title=Monomorphic versus polymorphic ventricular tachycardia after coronary artery bypass grafting|journal=The American Journal of Cardiology|volume=75|issue=5|year=1995|pages=403–405|issn=00029149|doi=10.1016/S0002-9149(99)80566-9}}</ref>
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| * [[Monomorphic VT]] may be related to , prior [[MI]], [[ventricular]] scar, LV dysfunction, and placement of a [[bypass graft]] across a [[noncollateralized]] occluded [[coronary vessel]] to a chronic [[infarct]] zone.
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| * Among [[patients]] without sustained [[VT]], [[VF]] and presence of [[LV]] dysfunction, reassessment of [[LV]] function 3 months after [[CABG]] for decision about [[ICD]] implantation is recommended.<ref name="VakilFlorea2016">{{cite journal|last1=Vakil|first1=Kairav|last2=Florea|first2=Viorel|last3=Koene|first3=Ryan|last4=Kealhofer|first4=Jessica Voight|last5=Anand|first5=Inderjit|last6=Adabag|first6=Selcuk|title=Effect of Coronary Artery Bypass Grafting on Left Ventricular Ejection Fraction in Men Eligible for Implantable Cardioverter–Defibrillator|journal=The American Journal of Cardiology|volume=117|issue=6|year=2016|pages=957–960|issn=00029149|doi=10.1016/j.amjcard.2015.12.029}}</ref>
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| * In [[patients]] with high burden of [[non-sustained VT]] and [[LV]] dysfunction, [[electrophysiology study]] for risk stratification and determination the need for [[ICD]] is recommended. <ref name="MittalLomnitz2002">{{cite journal|last1=Mittal|first1=Suneet|last2=Lomnitz|first2=David J.|last3=Mirchandani|first3=Sunil|last4=Stein|first4=Kenneth M.|last5=Markowitz|first5=Steven M.|last6=Slotwiner|first6=David J.|last7=Iwai|first7=Sei|last8=Das|first8=Mithilesh K.|last9=Lerman|first9=Bruce B.|title=Prognostic Significance of Nonsustained Ventricular Tachycardia After Revascularization|journal=Journal of Cardiovascular Electrophysiology|volume=13|issue=4|year=2002|pages=342–346|issn=1045-3873|doi=10.1046/j.1540-8167.2002.00342.x}}</ref><ref name="Bigger1997">{{cite journal|last1=Bigger|first1=J. Thomas|title=Prophylactic Use of Implanted Cardiac Defibrillators in Patients at High Risk for Ventricular Arrhythmias after Coronary-Artery Bypass Graft Surgery|journal=New England Journal of Medicine|volume=337|issue=22|year=1997|pages=1569–1575|issn=0028-4793|doi=10.1056/NEJM199711273372201}}</ref>
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| ==[[Secondary prevention]] in [[non-ischemic cardiomyopathy]]==
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| {| style="cellpadding=0; cellspacing= 0; width: 600px;"
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| | style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Recommendations for secondary prevention of sudden cardiac death in non-ischemic cardiomyopathy'''
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| |-
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| |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | '''[[ICD]] implantation ([[ACC AHA guidelines classification scheme|Class I, Level of Evidence B]]):'''
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| |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
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| ❑ [[ICD]] implantation is recommended in survivors of [[SCA]] or hemodynamically unstable [[VT]] or sustained [[VT]] not related to reversible causes, if life expectancy is more than 1 year<br>
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| |-
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| |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''ICD implantation, EPS study ([[ACC AHA guidelines classification scheme|Class IIa, Level of Evidence B]]) :'''
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| |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
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| ❑ In the presence of [[syncope]] presumed due to [[ventricular arrhythmia]], [[ICD]] or [[EPS]] study for risk stratification of [[SCD]] is recommended if survival is more than 1 year<br>
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| |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Amiodarone : ([[ACC AHA guidelines classification scheme|Class IIb, Level of Evidence B]])'''
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| |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
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| ❑ 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
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| |}
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| <span style="font-size:85%">'''Abbreviations:'''
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| '''ICD:''' [[Implantable cardioverter defibrillator]];
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| '''SCA:''' [[Sudden cardiac arrest]];
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| '''NICM''' [[Non ischemic cardiomyopathy]];
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| '''EPS''' [[Electrophysiology study]];
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| '''SCD''' [[Sudden cardiac death]];
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| '''VT''' [[Ventricular tachycardia]]
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| </span>
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| <br>
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| {|
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| ! colspan="2" style="background: PapayaWhip;" align="center" + |The above table adopted from 2017 AHA/ACC/HRS Guideline
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| |-
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| |}
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|
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| ==References==
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| {{reflist|2}}
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