Ventricular tachycardia secondary prevention: Difference between revisions

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{{Ventricular tachycardia}}
{{Ventricular tachycardia}}
{{CMG}}; '''Associate Editor-in Chief''': [[User:Avirupguha|Avirup Guha, M.B.B.S.]][mailto:avirup.guha@gmail.com]
{{CMG}}; '''Associate Editor-in Chief''': {{Sara.Zand}} [[User:Avirupguha|Avirup Guha, M.B.B.S.]][mailto:avirup.guha@gmail.com]
==Overview==
==Overview==
[[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]] was superior to [[antiarrhythmic]] drugs 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]], [[proarrhythmic]] medication effect may be corrected. [[ICD]] implantation improved outcome in well-tolerated [[VT]] and [[structurally heart disease]]. 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]].
==[[Secondary prevention]]==
==[[Secondary prevention]]==
<span style="font-size:85%">'''Abbreviations:'''
[[Secondary prevention]] strategies following [[SCA]] and unstable [[VT]] include [[ICD]] implantation, and [[medications]].
'''MI:''' [[Myocardial infarction]];
* 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>
'''VT:''' [[Ventricular tachycardia]];
 
'''VF:''' [[Ventricular fibrillation]];
* 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>
'''LVEF:''' [[Left ventricular ejection fraction]];
 
'''ICD:''' [[Intracardiac defibrillation]];
* [[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>
'''EPS:''' [[Electrophysiology study]]
 
</span>
* [[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>
<br>
 
* 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]]==


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<span style="font-size:85%">'''Abbreviations:'''
 
'''VT:''' [[Ventricular tachycardia]];
'''VF:''' [[Ventricular fibrillation]];
'''ICD:''' [[ Implantable cardioverter defibrillator]]
</span>
<br>
{|
! colspan="2" style="background: PapayaWhip;" align="center" + |The above table adopted from 2017 AHA/ACC/HRS Guideline
|-
|}<ref name="Al-KhatibStevenson2018">{{cite journal|last1=Al-Khatib|first1=Sana M.|last2=Stevenson|first2=William G.|last3=Ackerman|first3=Michael J.|last4=Bryant|first4=William J.|last5=Callans|first5=David J.|last6=Curtis|first6=Anne B.|last7=Deal|first7=Barbara J.|last8=Dickfeld|first8=Timm|last9=Field|first9=Michael E.|last10=Fonarow|first10=Gregg C.|last11=Gillis|first11=Anne M.|last12=Granger|first12=Christopher B.|last13=Hammill|first13=Stephen C.|last14=Hlatky|first14=Mark A.|last15=Joglar|first15=José A.|last16=Kay|first16=G. Neal|last17=Matlock|first17=Daniel D.|last18=Myerburg|first18=Robert J.|last19=Page|first19=Richard L.|title=2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death|journal=Circulation|volume=138|issue=13|year=2018|issn=0009-7322|doi=10.1161/CIR.0000000000000549}}</ref>




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{{Family tree | | | | | | | A01 | | | | A01=Secondary prevention in patients with [[IHD]]}}
{{Family tree | | | | | | | A01 | | | | A01=[[Secondary prevention]] in [[patients]] with [[IHD]]}}
{{Family tree | | | | |,|-|-|^|-|-|.| | }}
{{Family tree | | | | |,|-|-|^|-|-|.| | }}
{{Family tree | | | | B01 | | | | B02 | | |B01=[[SCA]] survivor or sustained monomorph [[VT]]|B02=Cardiac [[syncope]]}}
{{Family tree | | | | B01 | | | | B02 | | |B01=[[SCA]] survivor or sustained monomorph [[VT]]|B02=Cardiac [[syncope]]}}
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{{Family tree/end}}
{|
! colspan="2" style="background: PapayaWhip;" align="center" + |The above algorithm adopted from 2017 AHA/ACC/HRS Guideline
|-
|}<ref name="Al-KhatibStevenson2018">{{cite journal|last1=Al-Khatib|first1=Sana M.|last2=Stevenson|first2=William G.|last3=Ackerman|first3=Michael J.|last4=Bryant|first4=William J.|last5=Callans|first5=David J.|last6=Curtis|first6=Anne B.|last7=Deal|first7=Barbara J.|last8=Dickfeld|first8=Timm|last9=Field|first9=Michael E.|last10=Fonarow|first10=Gregg C.|last11=Gillis|first11=Anne M.|last12=Granger|first12=Christopher B.|last13=Hammill|first13=Stephen C.|last14=Hlatky|first14=Mark A.|last15=Joglar|first15=José A.|last16=Kay|first16=G. Neal|last17=Matlock|first17=Daniel D.|last18=Myerburg|first18=Robert J.|last19=Page|first19=Richard L.|title=2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death|journal=Circulation|volume=138|issue=13|year=2018|issn=0009-7322|doi=10.1161/CIR.0000000000000549}}</ref>
==[[Secondary prevention ]] in  [[patients]] with [[coronary spasm]]==
*[[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>
* [[Vasospasm]] mat lead to [[ventricular arrhythmia]], [[syncope]], and [[sudden cardiac death]].
* Prevention of [[vasospasm]]  may include [[smoking cessation]] and [[using]] [[dihyropyridine]] [[calcium channel blocker]] with or without [[nitrate]].
* 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>
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Recommendations for secondary prevention of sudden cardiac death in coronary spasm'''
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | '''[[ICD]] implantation  ([[ACC AHA guidelines classification scheme|Class I, Level of Evidence B]]):'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ 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>
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[ICD]] implantation ([[ACC AHA guidelines classification scheme|Class IIa, Level of Evidence B]]) :'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ 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>
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[ICD implantation]] : ([[ACC AHA guidelines classification scheme|Class IIb, Level of Evidence B]])'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ 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
|-
|}
<span style="font-size:85%">'''Abbreviations:'''
'''ICD:''' [[Implantable cardioverter defibrillator]];
'''SCA:''' [[Sudden cardiac arrest]]
</span>
<br>
{|
! colspan="2" style="background: PapayaWhip;" align="center" + |The above table adopted from 2017 AHA/ACC/HRS Guideline
|-
|}
==Post [[CABG]],[[VT]]/[[VF]]==
* [[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]].
* [[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>
* [[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.
* 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>
* 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>
==[[Secondary prevention]] in [[non-ischemic cardiomyopathy]]==
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| 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'''
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | '''[[ICD]] implantation  ([[ACC AHA guidelines classification scheme|Class I, Level of Evidence B]]):'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ [[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>
|-
|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]]) :'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ 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>
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Amiodarone : ([[ACC AHA guidelines classification scheme|Class IIb, Level of Evidence B]])'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ 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
|-
|}
<span style="font-size:85%">'''Abbreviations:'''
'''ICD:''' [[Implantable cardioverter defibrillator]];
'''SCA:''' [[Sudden cardiac arrest]];
'''NICM''' [[Non ischemic cardiomyopathy]];
'''EPS''' [[Electrophysiology study]];
'''SCD''' [[Sudden cardiac death]];
'''VT''' [[Ventricular tachycardia]]
</span>
<br>
{|
! colspan="2" style="background: PapayaWhip;" align="center" + |The above table adopted from 2017 AHA/ACC/HRS Guideline
|-
|}


==References==
==References==

Latest revision as of 09:09, 27 May 2021

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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 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 was superior to antiarrhythmic drugs 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, proarrhythmic medication effect may be corrected. ICD implantation improved outcome in well-tolerated VT and structurally heart disease. 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.

Secondary prevention

Secondary prevention strategies following SCA and unstable VT include ICD implantation, and medications.

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):

❑ 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) :

❑ 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)

❑ 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

The above table adopted from 2017 AHA/ACC/HRS Guideline

[5]




 
 
 
 
 
 
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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The above algorithm adopted from 2017 AHA/ACC/HRS Guideline

[5]

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):

❑ 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

ICD implantation (Class IIa, Level of Evidence B) :

❑ 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)

❑ 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

The above table adopted from 2017 AHA/ACC/HRS Guideline

Post CABG,VT/VF

Secondary prevention in non-ischemic cardiomyopathy

Recommendations for secondary prevention of sudden cardiac death in non-ischemic cardiomyopathy
ICD implantation (Class I, Level of Evidence B):

❑ 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

ICD implantation, EPS study (Class IIa, Level of Evidence B) :

❑ 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

Amiodarone : (Class IIb, Level of Evidence B)

❑ 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

Abbreviations: ICD: Implantable cardioverter defibrillator; SCA: Sudden cardiac arrest; NICM Non ischemic cardiomyopathy; EPS Electrophysiology study; SCD Sudden cardiac death; VT Ventricular tachycardia

The above table adopted from 2017 AHA/ACC/HRS Guideline

References

  1. ↑ "A Comparison of Antiarrhythmic-Drug Therapy with Implantable Defibrillators in Patients Resuscitated from Near-Fatal Ventricular Arrhythmias". New England Journal of Medicine. 337 (22): 1576–1584. 1997. doi:10.1056/NEJM199711273372202. ISSN 0028-4793.
  2. ↑ Wyse, D.George; Friedman, Peter L; Brodsky, Michael A; Beckman, Karen J; Carlson, Mark D; Curtis, Anne B; Hallstrom, Alfred P; Raitt, Merritt H; Wilkoff, Bruce L; Greene, H.Leon (2001). "Life-threatening ventricular arrhythmias due to transient or correctable causes: high risk for death in follow-up". Journal of the American College of Cardiology. 38 (6): 1718–1724. doi:10.1016/S0735-1097(01)01597-2. ISSN 0735-1097.
  3. ↑ Raitt, Merritt H.; Renfroe, Ellen Graham; Epstein, Andrew E.; McAnulty, John H.; Mounsey, Paul; Steinberg, Jonathan S.; Lancaster, Scott E.; Jadonath, Ram L.; Hallstrom, Alfred P. (2001). ""Stable" Ventricular Tachycardia Is Not a Benign Rhythm". Circulation. 103 (2): 244–252. doi:10.1161/01.CIR.103.2.244. ISSN 0009-7322.
  4. ↑ Maury, P.; Baratto, F.; Zeppenfeld, K.; Klein, G.; Delacretaz, E.; Sacher, F.; Pruvot, E.; Brigadeau, F.; Rollin, A.; Andronache, M.; Maccabelli, G.; Gawrysiak, M.; Brenner, R.; Forclaz, A.; Schlaepfer, J.; Lacroix, D.; Duparc, A.; Mondoly, P.; Bouisset, F.; Delay, M.; Hocini, M.; Derval, N.; Sadoul, N.; Magnin-Poull, I.; Klug, D.; Haissaguerre, M.; Jais, P.; Della Bella, P.; De Chillou, C. (2014). "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%". European Heart Journal. 35 (22): 1479–1485. doi:10.1093/eurheartj/ehu040. ISSN 0195-668X.
  5. ↑ 5.0 5.1 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.
  6. ↑ "Guidelines for diagnosis and treatment of patients with vasospastic angina (coronary spastic angina) (JCS 2008): digest version". Circ J. 74 (8): 1745–62. August 2010. doi:10.1253/circj.cj-10-74-0802. PMID 20671373.
  7. ↑ Morikawa, Yoshinobu; Mizuno, Yuji; Yasue, Hirofumi (2010). "Letter by Morikawa et al Regarding Article, "Coronary Artery Spasm: A 2009 Update"". Circulation. 121 (3). doi:10.1161/CIR.0b013e3181ce1bcc. ISSN 0009-7322.
  8. ↑ Saxon, Leslie A.; Wiener, Isaac; Natterson, Paul D.; Laks, Hillel; Drinkwater, Davis; Stevenson, William G.X. (1995). "Monomorphic versus polymorphic ventricular tachycardia after coronary artery bypass grafting". The American Journal of Cardiology. 75 (5): 403–405. doi:10.1016/S0002-9149(99)80566-9. ISSN 0002-9149.
  9. ↑ Vakil, Kairav; Florea, Viorel; Koene, Ryan; Kealhofer, Jessica Voight; Anand, Inderjit; Adabag, Selcuk (2016). "Effect of Coronary Artery Bypass Grafting on Left Ventricular Ejection Fraction in Men Eligible for Implantable Cardioverter–Defibrillator". The American Journal of Cardiology. 117 (6): 957–960. doi:10.1016/j.amjcard.2015.12.029. ISSN 0002-9149.
  10. ↑ Mittal, Suneet; Lomnitz, David J.; Mirchandani, Sunil; Stein, Kenneth M.; Markowitz, Steven M.; Slotwiner, David J.; Iwai, Sei; Das, Mithilesh K.; Lerman, Bruce B. (2002). "Prognostic Significance of Nonsustained Ventricular Tachycardia After Revascularization". Journal of Cardiovascular Electrophysiology. 13 (4): 342–346. doi:10.1046/j.1540-8167.2002.00342.x. ISSN 1045-3873.
  11. ↑ Bigger, J. Thomas (1997). "Prophylactic Use of Implanted Cardiac Defibrillators in Patients at High Risk for Ventricular Arrhythmias after Coronary-Artery Bypass Graft Surgery". New England Journal of Medicine. 337 (22): 1569–1575. doi:10.1056/NEJM199711273372201. ISSN 0028-4793.


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