Sudden cardiac death post arrest care and prevention: Difference between revisions

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| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for risk stratification and primary prevention of sudden cardiac death in dilated cardiomyopathy/ hypo kinetic non-dilated cardiomyopathy'''''
| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for primary prevention of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy '''''
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| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: A]])'''''
| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
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* [[ICD]] [[implantation]] should be considered in [[patients]] with [[DCM]]/[[HNDCM]], [[symptomatic]] [[heart failure]] ([[NYHA class II-III]]), and [[LVEF]] less than or equal to 35%, after at least 3 months of [[optimal medical therapy]].
* [[ICD]] [[implantation]] should be considered in [[patients]] with definite [[arrhythmogenic right ventricular cardiomyopathy]] ([[ARVC]]) and an [[arrhythmic]] [[syncope]].
|-
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| colspan="1" style="text-align:center; background:LemonChiffon|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
| colspan="1" style="text-align:center; background:LemonChiffon|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
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| bgcolor="LemonChiffon"|  
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* [[ICD]] [[implantation]] should be considered in [[DCM]]/ [[HNDCM]] [[patients]] with a [[pathogenic]] [[mutation]] in LMNA [[gene]], if the estimated 5-year [[risk]] of [[life-threatening]] [[VA]] is at least 10% and in the presence of [[NSVT]] or [[LVEF]] less than 50% or [[AV]] [[conduction delay]].
* [[ICD]] [[implantation]] should be considered in [[patients]] with definite [[ARVC]] and severe [[RV]] or [[LV]] [[systolic dysfunction]].
|-
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|colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
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| bgcolor="LemonChiffon"|  
| bgcolor="LemonChiffon"|  
* [[ICD]] [[implantation]] should be considered in [[DCM]]/[[HNDCM]] [[patients]] with a [[LVEF]] <50% and at least 2 [[risk factors]] ([[syncope]], [[LGE]] on [[CMR]], inducible [[SMVT]] at [[PES]], [[pathogenic mutations]] in LMNA, PLN, FLNC, and RBM20 [[genes]].
* [[ICD]] [[implantation]] should be considered in [[symptomatic]] [[patients]] with definite [[ARVC]], moderate right or left [[ventricular dysfunction]], and either [[NSVT]] or inducibility of [[SMVT]] at [[PES]].
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| colspan="1" style="text-align:center; background:Orange"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIb]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
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| bgcolor="LemonChiffon"|
* In [[patients]] with [[ARVC]] and [[symptoms]] highly suspicious for [[VA]], [[PES]] may be considered for [[risk stratification]].
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{|class="wikitable"
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| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for risk stratification and primary prevention of sudden cardiac death'''''
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| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
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| bgcolor="LightGreen"|
* In [[patients]] with [[syncope]] and previous [[ST elevation myocardial infarction]] ([[STEMI]]), [[programmed electrical stimulation]] ([[PES]]) is indicated when [[syncope]] remains unexplained after non-invasive evaluation.
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| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: A]])'''''
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* [[ICD]] [[therapy]] is recommended in [[patients]] with [[coronary artery disease]] ([[CAD]]), [[symptomatic heart failure]] [[NYHA class II-III]], and [[left ventricular ejection fraction]] ([[LVEF]]) less than or equal to 35% despite at least three months of optimal medical therapy ([[OMT]]).
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|colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
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* [[ICD]] [[therapy]] should be considered in [[patients]] with [[CAD]], [[NYHA class I]], [[LVEF]] less than or equal to 35% despite at least three months of optimal medical therapy ([[OMT]]).
|-
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
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| bgcolor="LemonChiffon"|
* [[ICD]] [[therapy]] should be considered in [[patients]] with [[CAD]],[[LVEF]] less than or equal to 40% despite at least three months of [[OMT]] and [[NSVT]], if they are inducible for [[SMVT]] by [[PES]].
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| colspan="1" style="text-align:center; background:Pink"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class III]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: A]])'''''
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* in [[patients]] with [[CAD]], [[prophylactic treatment]] with [[anti-arrhythmic drugs]] ([[AAD]]s) other than [[beta-blockers]] is not recommended.
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{|class="wikitable"
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| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for risk stratification and primary prevention of sudden cardiac death in hypertrophic cardiomyopathy'''''
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| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
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* It is recommended that the 5-year [[risk]] of [[SCD]] is assessed at first evaluation and at 1-3 year intervals, or when there is a change in [[clinical]] status.
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| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
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| bgcolor="LemonChiffon"|
* [[ICD]] [[implantation]] should be considered in [[patients]] [[age]]d 16 years or more with an estimated 5-year [[risk]] of [[SCD]] at least 6%.
|-
|colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
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* [[ICD]] [[implantation]] should be considered in [[HCM]] [[patients]] [[age]]d 16 years or more with an intermediate 5-year [[risk]] of [[SCD]] (more than or equal to 4 to less than or equal to 6%) and with (a) significant [[LGE]] at [[CMR]] (usually at least 15% of [[LV]] mass); or (b) [[LVEF]] less than 50%; or (c) abnormal [[blood pressure]] response during [[exercise test]]; or (d) [[LV]] [[apical]] [[aneurysm]]; or (e) presence of [[sarcomeric]] [[pathogenic]] [[mutation]].
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| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
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* In [[DCM]]/[[HNDCM]] [[patients]], [[electrophysiological]] evaluation should be considered when [[syncope]] remains unexplained after non-invasive evaluation.  
* In [[children]] less than 16 years of [[age]] with [[HCM]] and an estimated 5-year [[risk]] of [[sudden death]] at least 6% (based on [[HCM Risk-Kids Score]], [[ICD]] [[implantation]] should be considered.
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| colspan="1" style="text-align:center; background:Orange"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIb]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
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* [[ICD]] [[implantation]] may be considered in [[HCM]] [[patients]] [[age]]d 16 years or more with an estimated 5-year [[risk]] of [[SCD]] of at least 4 to less than 6%.
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| colspan="1" style="text-align:center; background:Orange"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIb]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
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* [[ICD]] [[implantation]] may be considered in [[HCM]] [[patients]] [[age]]d 16 years or more with a low estimated 5-year [[risk]] of [[SCD]] (<4%) and with (a) significant [[LGE]] at [[CMR]] (usually at least 15% of [[LV]] mass); or (b) [[LVEF]] < 50%; or (c) [[LV]] [[apical]] [[aneurysm]].
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| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for secondary prevention of sudden cardiac death and treatment of ventricular arrhythmias'''''
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| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
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| bgcolor="LightGreen"|
* [[ICD]] [[[implantation]] is recommended in [[patients]] with [[DCM]]/[[HNDCM]], who survive [[SCA]] due to [[VT]]/[[VF]] or experience hemodynamically not-tolerated [[SMVT]].
|-
| colspan="1" style="text-align:center; background:LemonChiffon|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
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* [[Catheter ablation]] in specialized centers should be considered in [[patients]] with [[DCM]]/[[HNDCm]] and [[recurrent]] [[symptomatic]] [[SMVT]] or [[ICD]] shocks for [[SMVT]], in whom [[AAD]]s are ineffective, contraindicated, or not tolerated.
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|colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
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* The addition of [[oral]] [[amiodarone]] or replacement of [[beta-blockers]] by [[sotalol]] should be considered in [[patients]] with [[DCM]]/[[HNDCM]] and an [[ICD]] who experience [[recurrent]], [[symptomatic]] [[VA]] despite optimal device programming and [[beta-blocker]] [[treatment]].
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| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
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| bgcolor="LemonChiffon"|
* [[ICD]] [[implantation]] should be considered in [[patients]] with [[DCM]]/[[HNDCM]] and [[hemodynamically]] tolerated [[SMVT]].
|}
{|class="wikitable"
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| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for secondary prevention of sudden cardiac death and treatment of ventricular arrhythmias in ARVC'''''
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| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
|-
| bgcolor="LightGreen"|
* [[ICD]] [[[implantation]] is recommended in [[[ARVC]] [[patients]] with hemodynamically not-tolerated [[VT]] or [[VF]].
|-
| colspan="1" style="text-align:center; background:LightGreen|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
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| bgcolor="LightGreen"|
* In [[patients]] with [[ARVC]] and non-sustained or sustained [[VA]]s, [[beta-blocker]] [[therapy]] is recommended.
|-
|colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="LemonChiffon"|
* In [[patients]] with [[ARVC]] and [[recurrent]], [[symptomatic]] [[SMVT]] or [[ICD]] shocks for [[SMVT]] despite [[beta-blockers]], [[catheter ablation]] in specialized centers should be considered.
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
|-
| bgcolor="LemonChiffon"|
* In [[ARVC]] [[patients]] with [[indication]] for [[ICD]]s, a [[device]] with the capability of [[ATP]] programming for [[SMVT]] up to high rates should be considered.
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="LemonChiffon"|
* [[ICD]] [[implantation]] should be considered in [[ARVC]] [[patients]] with a [[hemodynamically]] tolerated [[SMVT]].
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="LemonChiffon"|
* In [[patients]] with [[ARVC]] and [[recurrent]], [[symptomatic]] [[VT]] despite [[beta-blockers]], [[AAD]] [[treatment]] should be considered.
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for secondary prevention of sudden cardiac death and treatment of ventricular arrhythmias in hypertrophic cardiomyopathy'''''
|-
| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
|-
| bgcolor="LightGreen"|
* [[ICD]] [[[implantation]] is recommended in [[HCM]] [[patients]] with hemodynamically not-tolerated [[VT]] or [[VF]].
|-
| colspan="1" style="text-align:center; background:LemonChiffon|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="LemonChiffon"|
* In [[patients]] with [[HCM]] presenting with hemodynamically tolerated [[SMVT]], [[ICD]] [[implantaiton]] should be considered.
|-
|colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="LemonChiffon"|
* In [[patients]] with [[HCM] and [[recurrent]], [[symptomatic]] [[VA] or [[recurrent]] [[ICD]] [[therapy]], [[AAD]] [[treatment]] should be considered.
|-
| colspan="1" style="text-align:center; background:Orange"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIb]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
|-
| bgcolor="Orange"|
* [[Catheter ablation]] in specialized centers may be considered in selected [[patients]] with [[HCM]] and [[recurent]], [[symptomatic]] [[SMVT]] or [[ICD]] shocks for [[SMVT]], in whom [[AAD]] are ineffective, [[contraindicated]], or not tolerated.
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====Implantable Cardioverter Defibrillator====
====Implantable Cardioverter Defibrillator====
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* It is not recommended to [[implant]] an [[ICD]] in [[patients]] with incessant [[ventricular arrhythmia's]] ([[VA]]s) until the [[VA]] is controlled.
* It is not recommended to [[implant]] an [[ICD]] in [[patients]] with incessant [[ventricular arrhythmia's]] ([[VA]]s) until the [[VA]] is controlled.
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{|class="wikitable"
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| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for implantable cardioverter defibrillator implantation in left ventricular non-compaction'''''
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| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
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* In [[patients]] with a [[left ventricular non-compaction]] ([[LVNC]]) [[cardiomyopathy]] [[phenotype]] based on [[CMR]] or [[echocardiography]], [[implantation]] of an [[ICD]] for [[primary prevention]] of [[SCD]] should be considered to follow [[DCM]]/ [[HNDCM]] recommendations.
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{|class="wikitable"
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| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for implantable cardioverter defibrillator implantation in patients with cardiac amyloidosis'''''
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| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
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* An [[ICD]] should be considered in [[patients]] with [[light-chain amyloidosis]] or [[transthyretin-associated cardiac amyloidosis]] and [[hemodynamically]] not-tolerated [[VT]].
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{|class="wikitable"
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| colspan="1" style="text-align:center; background: Silver"|'''Recommendation for diagnosis and management of ventricular arryhthmia in neuromuscular diseases'''''
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| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
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* [[Invasive]] [[electrophysiological]] [[evaluation]] is recommended in [[patients]] with [[myotonic dystrophy]] and [[palpitations]] or [[syncope]] suggestive of [[VA]] or surviving a [[cardiac arrest]].
|-
| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
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| bgcolor="LightGreen"|
* [[ICD]] [[implantation]] is recommended in [[patients]] with [[myotonic dystrophy]] and [[SMVT]] or [[aborted]] [[cardiac arrest]] not caused by [[bundle branch re-entrant ventricular tachycardia]] ([[BBR-VT]]).
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
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| bgcolor="LemonChiffon"|
* [[Invasive]] [[electrophysiological evaluation]] should be considered in [[patients]] with [[myotonic dystrophy]] and a sudden increase in the [[PR interval]] or [[QRS duration]].
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
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* [[Invasive]] [[electrophysiological evaluation]] should be considered in [[patients]] with [[myotonic dystrophy]] and a [[PR interval]] at least 240 ms or [[QRS duration]] at least 120 ms or who are older than 40 years and have [[supraventricular]] [[arrhythmias]] or who are older than 40 years and have significant [[LGE]] on [[CMR]].
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| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
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| bgcolor="LemonChiffon"|
*In [[myotonic dystrophy]] [[patients]] without [[AV conduction delay]] and a [[syncope]] highly suspicious for [[VA]], [[ICD]] [[implantation]] should be considered.
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="LemonChiffon"|
*In [[myotonic dystrophy]] [[patients]] with [[palpitations]] highly suspicious for [[VA]] and [[induction]] of a [[bundle branch re-entrant ventricular tachycardia]] ([[BBR-VT]]), [[ICD]] [[implantation]] should be considered.
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="LemonChiffon"|
*In [[patients]] with [[limb girdle]] type IB or  [[Emery-Dreifuss muscular dystrophies]] and [[indication]] for [[pacing]], [[ICD]] [[implantation]] should be considered.
|-
| colspan="1" style="text-align:center; background:Orange"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIb]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="Orange"|
*[[Implantation]] of an [[ICD]] may be considered in [[patients]] with [[Duchenne/ Becker muscular dystrophy]] and significant [[LGE]] at [[CMR]].
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIb]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
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| bgcolor="Orange"|
*[[Implantation]] of an [[ICD]] over a permanent [[pacemaker]] may be considered in [[myotonic dystrophy]] [[patients]] with additional [[risk factors]] for [[VA]]s and [[SCD]].
|-
| colspan="1" style="text-align:center; background:Pink"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class III]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="Pink"|
*In [[myotonic dystrophy]] [[patients]], serial [[electrophysiological evaluation]] of [[AV conduction]] and [[arrhythmia]] [[induction]] is not recommended without [[arrhythmia]] suspicion or progression of [[ECG]] [[conduction disorders]].
|}
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Latest revision as of 22:49, 23 July 2023

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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] Edzel Lorraine Co, DMD, MD[3]

See also Post cardiac arrest syndrome care pathway

Overview

Prevention

2022 ESC Guidelines for the management of patients with ventricular arrythymias and the prevention of sudden cardiac death [2]

Primary Prevention of Sudden Cardiac Death

Recommendations for risk stratification and primary prevention of sudden cardiac death
Class I (Level of Evidence: C)
Class I (Level of Evidence: A)
Class IIa (Level of Evidence: B)
Class IIa (Level of Evidence: B)
Class III (Level of Evidence: A)
Recommendations for primary prevention of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy
Class IIa (Level of Evidence: B)
Class IIa (Level of Evidence: C)
Class IIa (Level of Evidence: C)
Class IIb (Level of Evidence: C)
Recommendations for risk stratification and primary prevention of sudden cardiac death
Class I (Level of Evidence: C)
Class I (Level of Evidence: A)
Class IIa (Level of Evidence: B)
Class IIa (Level of Evidence: B)
Class III (Level of Evidence: A)
Recommendations for risk stratification and primary prevention of sudden cardiac death in hypertrophic cardiomyopathy
Class I (Level of Evidence: C)
  • It is recommended that the 5-year risk of SCD is assessed at first evaluation and at 1-3 year intervals, or when there is a change in clinical status.
Class I (Level of Evidence: B)
Class IIa (Level of Evidence: B)
Class IIa (Level of Evidence: B)
Class IIb (Level of Evidence: B)
Class IIb (Level of Evidence: B)

Secondary Prevention of Sudden Cardiac Death

Recommendations for secondary prevention of sudden cardiac death and treatment of ventricular arrhythmias
Class I (Level of Evidence: A)
Class I (Level of Evidence: B)
Class IIa (Level of Evidence: B)
Class IIa (Level of Evidence: C)
Class IIa (Level of Evidence: C)
Class IIa (Level of Evidence: C)
Class IIb (Level of Evidence: B)
Recommendations for secondary prevention of sudden cardiac death and treatment of ventricular arrhythmias
Class I (Level of Evidence: B)
Class IIa (Level of Evidence: C)
Class IIa (Level of Evidence: B)
Class IIa (Level of Evidence: C)
Recommendations for secondary prevention of sudden cardiac death and treatment of ventricular arrhythmias in ARVC
Class I (Level of Evidence: B)
  • ICD [[[implantation]] is recommended in [[[ARVC]] patients with hemodynamically not-tolerated VT or VF.
Class I (Level of Evidence: C)
Class IIa (Level of Evidence: C)
Class IIa (Level of Evidence: B)
Class IIa (Level of Evidence: C)
Class IIa (Level of Evidence: C)
Recommendations for secondary prevention of sudden cardiac death and treatment of ventricular arrhythmias in hypertrophic cardiomyopathy
Class I (Level of Evidence: B)
  • ICD [[[implantation]] is recommended in HCM patients with hemodynamically not-tolerated VT or VF.
Class IIa (Level of Evidence: C)
Class IIa (Level of Evidence: C)
Class IIb (Level of Evidence: B)

Implantable Cardioverter Defibrillator

Recommendations for implantable cardioverter defibrillator implantation (general aspects)
Class I (Level of Evidence: C)
Class III (Level of Evidence: C)
Recommendations for subcutaneous implantable cardioverter defibrillator
Class IIa (Level of Evidence: B)
Class III (Level of Evidence: C)
Recommendations for implantable cardioverter defibrillator implantation in left ventricular non-compaction
Class IIa (Level of Evidence: C)
Recommendations for implantable cardioverter defibrillator implantation in patients with cardiac amyloidosis
Class IIa (Level of Evidence: C)
Recommendation for diagnosis and management of ventricular arryhthmia in neuromuscular diseases
Class I (Level of Evidence: C)
Class I (Level of Evidence: C)
Class IIa (Level of Evidence: B)
Class IIa (Level of Evidence: B)
Class IIa (Level of Evidence: C)
Class IIa (Level of Evidence: C)
Class IIa (Level of Evidence: C)
Class IIb (Level of Evidence: C)
Class IIb (Level of Evidence: C)
Class III (Level of Evidence: C)

2017AHA/ACC/HRS Guideline for management of sudden cardiac arrest and ventricular arrhythmia

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

Recommendations for primary prevention of sudden cardiac death in ischemic heart disease
ICD implantation (Class I, Level of Evidence A):

❑ 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
1 year

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

❑ 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)

❑ 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)

ICD is not beneficial in patients with NYHA class 4 despite optimal medical therapy who are not candidates for cardiac transplantation or LVAD


 
 
 
 
 
 
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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Timing of Sudden Cardiac Death Following ST-elevation MI

Patients with STEMI are at risk of sudden cardiac death. The timing of sudden cardiac death following STEMI is as follows:

Medical Therapy to Prevent Sudden Death Following STEMI

Beta Blockers

ACE Inhibitor

Angiotensin II Receptor Blockers (ARBs)

Statin Therapy

Aldosterone Antagonists

Anti-arrhythmics

Induced Hypothermia to Improve Neurological Outcome

[13]

Prevention of Sudden Death and Implantable Cardioverter Defibrillators Following STEMI

Role of Electrophysiology Testing

The Benefit of ICD Implantation May Be Greater in Patients with a QRS Duration > 120 msec

  • In both SCD-HeFT and MADIT II, the reduction in SCD was greater in patients with a QRS duration > 120 msec.

Wearable Defibrillators

In patients with a large MI with a low EF who are awaiting permanent ICD implantation, the use of a wearable defibrillator is a reasonable strategy.

Cardiac resynchronization therapy (CRT) Combined with ICD Placement

Based upon the results of the COMPANION trial it is reasonable to place a combined ICD / CRT device in patients with the following:

See also

References

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