Ventricular tachycardia primary 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]
Overview
Primary prevention strategy for heart failure patients with NYHA class II or III, and LVEF ≤35% at least 40 days after myocardial infarction is ICD implantation. In patients with LVEF ≤30% and prior MI and NYHA class I symptoms , ICD implantation was associated with survival benefit. Analysis of MADIT, MADIT-II, and SCD-HeFT showed survival benefit of ICD implantation for primary prevention of ventricular arrhythmia. There is not survival benefit of ICD implantation in patients with NYHA class IV heart failure.
Primary Prevention
- Primary prevention strategy for heart failure patients with NYHA class II or III, and LVEF ≤35% at least 40 days after myocardial infarction is ICD implantation.[1]
- In patients with LVEF ≤30% and prior MI and NYHA class I symptoms , ICD implantation was associated with survival benefit.[2]
- Analysis of MADIT, MADIT-II, and SCD-HeFT showed survival benefit of ICD implantation for primary prevention of ventricular arrhythmia.
- There was not survival benefit of ICD implantation in patients with NYHA class IV heart failure.[3]
| Recommendations for primary prevention of sudden cardiac death in ischemic heart disease |
| ICD implantation (Class I, Level of Evidence A): |
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❑ In patients with LVEF≤ 35% and NYHA class 2,3 heart failure despite medical therapy, at least 40 days post MI or 90 days post revascularization with life expectancy > 1 year |
| ICD implantation (Class I, Level of Evidence B) : |
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❑ In patients with LVEF ≤ 40% and nonsustained VT due to prior MI or VT ,VF inducible in EPS with life expectancy >1 year |
| ICD implantation : (Class IIa, Level of Evidence B) |
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❑ In patients with NYHA class 4 who are candidates for cardiac transplantation or LVAD with life expectancy > 1 year |
| (Class III, Level of Evidence C) |
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❑ ICD is not beneficial in patients with NYHA class 4 despite optimal medical therapy who are not candidates for cardiac transplantation or LVAD |
Abbreviations:
MI: Myocardial infarction;
VT: Ventricular tachycardia;
VF: Ventricular fibrillation;
LVEF: Left ventricular ejection fraction;
ICD: Implantable cardioverter defibrillator;
NYHA: New York Heart Association functional classification;
LVAD: Left ventricular assist device;
EPS: Electrophysiology study
| The above table adopted from 2017 AHA/ACC/HRS Guideline |
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| Recommendations for primary prevention of sudden cardiac death in non-ischemic heart disease |
| ICD implantation (Class I, Level of Evidence A): |
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❑ In patients with LVEF≤ 35% and NYHA class 2,3 heart failure despite medical therapy with survival > 1 year |
| ICD implantation (Class IIa, Level of Evidence B) : |
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❑ In patients with more than 2 risk factors related to cardiomyopathy lamin A/C mutation (LVEF ≤ 45% and nonsustained VT, non missense mutation, male sex), ICD implantation with life expectancy> 1 year |
| ICD implantation : (Class IIb, Level of Evidence B) |
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❑ In patients with NYHA class 1 heart failure and LVEF <35% despite optimal medical therapy, ICD is recommended if life expectancy>1 year |
| (Class III, Level of Evidence C) |
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❑ ICD is not beneficial in patients with NYHA class 4 despite optimal medical therapy who are not candidates for cardiac transplantation or LVAD or CRT defibrillator |
Abbreviations:
MI: Myocardial infarction;
VT: Ventricular tachycardia;
VF: Ventricular fibrillation;
LVEF: Left ventricular ejection fraction;
ICD: Implantable cardioverter defibrillator;
NYHA: New York Heart Association functional classification;
LVAD: Left ventricular assist device;
EPS: Electrophysiology study;
CRT Cardiac resynchronization therapy
| The above table adopted from 2017 AHA/ACC/HRS Guideline |
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References
- ↑ Hohnloser, Stefan H.; Kuck, Karl Heinz; Dorian, Paul; Roberts, Robin S.; Hampton, John R.; Hatala, Robert; Fain, Eric; Gent, Michael; Connolly, Stuart J. (2004). "Prophylactic Use of an Implantable Cardioverter–Defibrillator after Acute Myocardial Infarction". New England Journal of Medicine. 351 (24): 2481–2488. doi:10.1056/NEJMoa041489. ISSN 0028-4793.
- ↑ Steinbeck, Gerhard; Andresen, Dietrich; Seidl, Karlheinz; Brachmann, Johannes; Hoffmann, Ellen; Wojciechowski, Dariusz; Kornacewicz-Jach, Zdzisława; Sredniawa, Beata; Lupkovics, Géza; Hofgärtner, Franz; Lubinski, Andrzej; Rosenqvist, Mårten; Habets, Alphonsus; Wegscheider, Karl; Senges, Jochen (2009). "Defibrillator Implantation Early after Myocardial Infarction". New England Journal of Medicine. 361 (15): 1427–1436. doi:10.1056/NEJMoa0901889. ISSN 0028-4793.
- ↑ Bristow, Michael R.; Saxon, Leslie A.; Boehmer, John; Krueger, Steven; Kass, David A.; De Marco, Teresa; Carson, Peter; DiCarlo, Lorenzo; DeMets, David; White, Bill G.; DeVries, Dale W.; Feldman, Arthur M. (2004). "Cardiac-Resynchronization Therapy with or without an Implantable Defibrillator in Advanced Chronic Heart Failure". New England Journal of Medicine. 350 (21): 2140–2150. doi:10.1056/NEJMoa032423. ISSN 0028-4793.
- ↑ 4.0 4.1 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.