Ventricular tachycardia other disgnostic tests
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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] Aditya Ganti M.B.B.S. [3]
Overview
Coronary angiography has an important role in diagnosis and treatment of myocardial ischemia-induced life-threatening VT, VF. Myocardial ischemia may induce recurrent polymorphic VT, or VF and is treatable by coronary revascularization.
- Evidence of ST segment elevation or early post resuscitated ECG changes suggestive of ischemia may lead to ventricular arrhythmia and sudden cardiac arrest and required urgent revascularization. In patients with low evidence of myocardial ischemia, coronary angiography is not recommended. For patients suspected anomalous origin of the coronary arteries leading SCA , coronary angiography is warranted.
Coronary Angiography
- Coronary angiography has an important role in diagnosis and treatment of myocardial ischemia-induced life-threatening VT, VF.[1]
- Myocardial ischemia may induce recurrent polymorphic VT, or VF and is treatable by coronary revascularization.
- Evidence of ST segment elevation or early post resuscitated ECG changes suggestive of ischemia may lead to ventricular arrhythmia and sudden cardiac arrest and
required urgent revascularization.[2]
- ST elevation can be present early after resuscitation due to DC shock and also coronary vasospasm.
- Even in the absence of ST elevation or other ECG changes, the obstruction of coronary arteries or thrombosis maybe found in coronary angiography.[1]
- In patients with low evidence of myocardial ischemia, coronary angiography is not recommended.
- For patients suspected anomalous origin of the coronary arteries leading SCA , coronary angiography is warranted.
2017 AHA/ACC/HRS Guidelines for Management of Patients With Ventricular Arrhythmia
| Class I |
| "1. Coronary angiography is recommended in survivors of sudden cardiac arrest suspected ischemic heart disease for guiding decision about appropriate coronary revascularization (Level of Evidence C)" |
Electrophysiological study
- Electrophysiologic study is used to determine the mechanism of ventricular arrhythmia and also induction of ventricular arrhythmia in patients with known or suspected ventricular arrhythmia.
- In heart failure patients with LVEF≤ 35% candidate for ICD implantation, programmed induction of VT, VF before ICD implantation is not recommended.[3]
- In the presence of frequent episodes of syncope and LVEF>35% suspected VT, or VF syncope, electrophysiological study is warranted.
- Befor catheter ablation, electrophysiologic study is needed to guide the procedure and to determine the success of the intervention after ablation.
- Among patients with ischemic cardiomyopathy, mortality was correlated with induction of VT, VF in electrophysiological study.
- In non-ischemic cardiomyopathy, mortality was associated with low LVEF , NOT induction of VT, VF. [4]
- In patients who meet criteria for ICD implantation (heart failure reduced EF), [[electrophysiology study is not indicated.
- Electrophysiology study is warranted in patients suspected to have preexcitation or supraventricular arrhythmias leading to VT/VF to induction of ventricular arrhythmia and ablation.
- For risk stratification of cardiac channelopathy such as Long QT syndrome, electrophysiological study is not recommended.[5]
References
- ↑ 1.0 1.1 Dumas, Florence; Bougouin, Wulfran; Geri, Guillaume; Lamhaut, Lionel; Rosencher, Julien; Pène, Frédéric; Chiche, Jean-Daniel; Varenne, Olivier; Carli, Pierre; Jouven, Xavier; Mira, Jean-Paul; Spaulding, Christian; Cariou, Alain (2016). "Emergency Percutaneous Coronary Intervention in Post–Cardiac Arrest Patients Without ST-Segment Elevation Pattern". JACC: Cardiovascular Interventions. 9 (10): 1011–1018. doi:10.1016/j.jcin.2016.02.001. ISSN 1936-8798.
- ↑ O’Gara, Patrick T.; Kushner, Frederick G.; Ascheim, Deborah D.; Casey, Donald E.; Chung, Mina K.; de Lemos, James A.; Ettinger, Steven M.; Fang, James C.; Fesmire, Francis M.; Franklin, Barry A.; Granger, Christopher B.; Krumholz, Harlan M.; Linderbaum, Jane A.; Morrow, David A.; Newby, L. Kristin; Ornato, Joseph P.; Ou, Narith; Radford, Martha J.; Tamis-Holland, Jacqueline E.; Tommaso, Carl L.; Tracy, Cynthia M.; Woo, Y. Joseph; Zhao, David X. (2013). "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction". Circulation. 127 (4). doi:10.1161/CIR.0b013e3182742cf6. ISSN 0009-7322.
- ↑ Brembilla-Perrot, Béatrice; Suty-Selton, Christine; Beurrier, Daniel; Houriez, Pierre; Nippert, Marc; Terrier de la Chaise, Arnaud; Louis, Pierre; Claudon, Olivier; Andronache, Marius; Abdelaah, Ahmed; Sadoul, Nicolas; Juillière, Yves (2004). "Differences in Mechanisms and Outcomes of Syncope in Patients With Coronary Disease or Idiopathic Left Ventricular Dysfunction as Assessed by Electrophysiologic Testing". Journal of the American College of Cardiology. 44 (3): 594–601. doi:10.1016/j.jacc.2004.03.075. ISSN 0735-1097.
- ↑ Gatzoulis, Konstantinos A.; Vouliotis, Apostolos-Ilias; Tsiachris, Dimitris; Salourou, Maria; Archontakis, Stefanos; Dilaveris, Polychronis; Gialernios, Theodoros; Arsenos, Petros; Karystinos, Georgios; Sideris, Skevos; Kallikazaros, Ioannis; Stefanadis, Christodoulos (2013). "Primary Prevention of Sudden Cardiac Death in a Nonischemic Dilated Cardiomyopathy Population". Circulation: Arrhythmia and Electrophysiology. 6 (3): 504–512. doi:10.1161/CIRCEP.113.000216. ISSN 1941-3149.
- ↑ Garson, A; Dick, M; Fournier, A; Gillette, P C; Hamilton, R; Kugler, J D; van Hare, G F; Vetter, V; Vick, G W (1993). "The long QT syndrome in children. An international study of 287 patients". Circulation. 87 (6): 1866–1872. doi:10.1161/01.CIR.87.6.1866. ISSN 0009-7322.