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.
- Based on meta-analysis of AVID trial implantation of ICD for secondary prevention of ventricular arrhythmia improved survival compared with antiarrhythmic in patients who survived of sudden cardiac arrest or unstable VT.
- Before ICD implantation, the reversible causes of ventricular arrhythmia including myocardial ischemia, electrolyte disturbance, proarrhythmiac medication effect may be corrected.
- ICD implantation improved outcome in well-tolerated VT and structurally heart disease.
- VT ablation reduced recurrence, but the effect on long-term mortality was unknown.
- 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.
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): |
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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. |
| ICD implantation (Intermediate value statement, Level of Evidence B) : |
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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. |
| ICD implantation : (Class I, Level of Evidence B) |
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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 |
Abbreviations:
VT: Ventricular tachycardia;
VF: Ventricular fibrillation;
ICD: Implantable cardioverter defibrillator
| 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 | ||||||||||||||||||||||||||||||||||||||||||||
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): |
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❑ In patients with ventricular arrhythmia due to coronary artery spasm, smoking cessation and calcium channel blocker with maximum tolerated doses is recommended |
| ICD implantation (Class IIa, Level of Evidence B) : |
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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 |
| ICD implantation : (Class IIb, Level of Evidence B) |
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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 |
Abbreviations:
ICD: Implantable cardioverter defibrillator;
SCA: Sudden cardiac arrest