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Latest revision as of 22:49, 23 July 2023

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]

Overview

Effective measures for the primary prevention of sudden cardiac death (SCD) in individuals who are at risk of SCD but have not yet experienced an aborted cardiac arrest or life-threatening arrhythmias include implantable cardioverter defibrillator (ICD) based on the guideline.
Secondary prevention strategy following aborted sudden cardiac death include revascularization in patients with ischemic heart disease and ICD implantation in patients with reduced left ventricular ejection fraction who had an experience of lethal arrhythmia.
The optimal approach to prevention of SCD following ST-elevation MI (STEMI) has been evaluated in multiple randomized trials. In general, post-STEMI patients should be treated with evidence-based therapies that have been associated with a reduction in SCD including beta-blockers, ACE-inhibitors (or ARBs in patients who are ACEI intolerant) and statins.
In patients who have symptomatic congestive heart failure (CHF), an aldosterone antagonist may be a reasonable additional therapy. Despite the intuitive benefits of antiarrhythmic, amiodarone and sotalol have not been shown to reduce all-cause mortality following STEMI, although amiodarone may be useful in reducing the frequency of shocks in patients with ICDs who have unacceptably high rates of shock.
In general terms, ICD placement is indicated in those patients with a reduced left ventricular ejection fraction at 40 days post-MI and/or 3 months following revascularization (PCI or CABG) for STEMI given the survival benefits in this population.

Prevention

Effective measures for the primary prevention of sudden cardiac death in individuals who are at risk of SCD but have not yet experienced an aborted cardiac arrest or life-threatening arrhythmias include ICD implantation based on the guideline.^[1]
Secondary prevention strategy following aborted sudden cardiac death include revascularization, ICD implantation.

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)
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.
Class I (Level of Evidence: A)
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).
Class IIa (Level of Evidence: B)
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).
Class IIa (Level of Evidence: B)
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.
Class III (Level of Evidence: A)
in patients with CAD, prophylactic treatment with anti-arrhythmic drugs (AADs) other than beta-blockers is not recommended.

Recommendations for primary prevention of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy
Class IIa (Level of Evidence: B)
ICD implantation should be considered in patients with definite arrhythmogenic right ventricular cardiomyopathy (ARVC) and an arrhythmic syncope.
Class IIa (Level of Evidence: C)
ICD implantation should be considered in patients with definite ARVC and severe RV or LV systolic dysfunction.
Class IIa (Level of Evidence: C)
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.
Class IIb (Level of Evidence: C)
In patients with ARVC and symptoms highly suspicious for VA, PES may be considered for risk stratification.

Recommendations for risk stratification and primary prevention of sudden cardiac death
Class I (Level of Evidence: C)
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.
Class I (Level of Evidence: A)
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).
Class IIa (Level of Evidence: B)
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).
Class IIa (Level of Evidence: B)
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.
Class III (Level of Evidence: A)
in patients with CAD, prophylactic treatment with anti-arrhythmic drugs (AADs) other than beta-blockers is not recommended.

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)
ICD implantation should be considered in patients aged 16 years or more with an estimated 5-year risk of SCD at least 6%.
Class IIa (Level of Evidence: B)
ICD implantation should be considered in HCM patients aged 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.
Class IIa (Level of Evidence: B)
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.
Class IIb (Level of Evidence: B)
ICD implantation may be considered in HCM patients aged 16 years or more with an estimated 5-year risk of SCD of at least 4 to less than 6%.
Class IIb (Level of Evidence: B)
ICD implantation may be considered in HCM patients aged 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.

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)
ICD implantation is recommended in patients without ongoing [ischemia]] with documented ventricular fibrillation or hemodynamically not-tolerated ventricular tachycardia occurring after than 48 hours after myocardial infarction.
Class I (Level of Evidence: B)
In patients with coronary artery disease (CAD) and recurrent, symptomatic SMVT or ICD shocks for SMVT despite chronic amiodarone therapy, catheter ablation is recommended in preference to escalating anti-arrhythmic drug therapy.
Class IIa (Level of Evidence: B)
The addition of oral amiodarone or beta-blocker replacement by sotalol should be considered in patients with coronary artery disease (CAD) with recurrent, symptomatic SMVT, or ICD shocks for SMVT while on beta-blocker treatment.
Class IIa (Level of Evidence: C)
In patients with CAD and hemodynamically well-tolerated SMVT and LVEF greater than or equal to 40%, catheter ablation in experienced centers should be considered as an alternative to ICD therapy, provided that established endpoints have been reached.
Class IIa (Level of Evidence: C)
ICD implantation should be considered in patients with a hemodynamically tolerated SMVT and an LVEF greater than or equal to 40% if VT ablation fails, is not available, or is not desired.
Class IIa (Level of Evidence: C)
Catheter ablation should be considered in patients with CAD and recurrent, symptomatic SMVT, or ICD shocks for SMVT despite beta-blockers or sotalol treatment.
Class IIb (Level of Evidence: B)
In patients with CAD eligible for ICD implantation, catheter ablation may be considered just before (or immediately after) ICD implantation to decrease subsequent VT burden and ICD shocks.

Recommendations for secondary prevention of sudden cardiac death and treatment of ventricular arrhythmias
Class I (Level of Evidence: B)
ICD [[[implantation]] is recommended in patients with DCM/HNDCM, who survive SCA due to VT/VF or experience hemodynamically not-tolerated SMVT.
Class IIa (Level of Evidence: C)
Catheter ablation in specialized centers should be considered in patients with DCM/HNDCm and recurrent symptomatic SMVT or ICD shocks for SMVT, in whom AADs are ineffective, contraindicated, or not tolerated.
Class IIa (Level of Evidence: B)
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.
Class IIa (Level of Evidence: C)
ICD implantation should be considered in patients with DCM/HNDCM and hemodynamically tolerated SMVT.

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)
In patients with ARVC and non-sustained or sustained VAs, beta-blocker therapy is recommended.
Class IIa (Level of Evidence: C)
In patients with ARVC and recurrent, symptomatic SMVT or ICD shocks for SMVT despite beta-blockers, catheter ablation in specialized centers should be considered.
Class IIa (Level of Evidence: B)
In ARVC patients with indication for ICDs, a device with the capability of ATP programming for SMVT up to high rates should be considered.
Class IIa (Level of Evidence: C)
ICD implantation should be considered in ARVC patients with a hemodynamically tolerated SMVT.
Class IIa (Level of Evidence: C)
In patients with ARVC and recurrent, symptomatic VT despite beta-blockers, AAD treatment should be considered.

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)
In patients with HCM presenting with hemodynamically tolerated SMVT, ICD implantaiton should be considered.
Class IIa (Level of Evidence: C)
In patients with [[HCM] and recurrent, symptomatic [[VA] or recurrent ICD therapy, AAD treatment should be considered.
Class IIb (Level of Evidence: B)
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.

Implantable Cardioverter Defibrillator

Recommendations for implantable cardioverter defibrillator implantation (general aspects)
Class I (Level of Evidence: C)
Implantation of a cardioverter defibrillator is only recommended in patients who have an expectation of good quality survival > 1 year.
Class III (Level of Evidence: C)
It is not recommended to implant an ICD in patients with incessant ventricular arrhythmia's (VAs) until the VA is controlled.

Recommendations for subcutaneous implantable cardioverter defibrillator
Class IIa (Level of Evidence: B)
Subcutaneous defibrillator should be considered as an alternative to transvenous defibrillator in patients with an indication for an ICD when pacing therapy for bradycardia, cardiac resynchronization, or anti-tachycardia pacing (ATP) is not needed.
Class III (Level of Evidence: C)
It is not recommended to implant an ICD in patients with incessant ventricular arrhythmia's (VAs) until the VA is controlled.

Recommendations for implantable cardioverter defibrillator implantation in left ventricular non-compaction
Class IIa (Level of Evidence: C)
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.

Recommendations for implantable cardioverter defibrillator implantation in patients with cardiac amyloidosis
Class IIa (Level of Evidence: C)
An ICD should be considered in patients with light-chain amyloidosis or transthyretin-associated cardiac amyloidosis and hemodynamically not-tolerated VT.

Recommendation for diagnosis and management of ventricular arryhthmia in neuromuscular diseases
Class I (Level of Evidence: C)
Invasive electrophysiological evaluation is recommended in patients with myotonic dystrophy and palpitations or syncope suggestive of VA or surviving a cardiac arrest.
Class I (Level of Evidence: C)
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).
Class IIa (Level of Evidence: B)
Invasive electrophysiological evaluation should be considered in patients with myotonic dystrophy and a sudden increase in the PR interval or QRS duration.
Class IIa (Level of Evidence: B)
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.
Class IIa (Level of Evidence: C)
In myotonic dystrophy patients without AV conduction delay and a syncope highly suspicious for VA, ICD implantation should be considered.
Class IIa (Level of Evidence: C)
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.
Class IIa (Level of Evidence: C)
In patients with limb girdle type IB or Emery-Dreifuss muscular dystrophies and indication for pacing, ICD implantation should be considered.
Class IIb (Level of Evidence: C)
Implantation of an ICD may be considered in patients with Duchenne/ Becker muscular dystrophy and significant LGE at CMR.
Class IIb (Level of Evidence: C)
Implantation of an ICD over a permanent pacemaker may be considered in myotonic dystrophy patients with additional risk factors for VAs and SCD.
Class III (Level of Evidence: C)
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.

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:

In the first 3 months after STEMI, one-quarter of sudden cardiac deaths occur. This statistic is critical in so far as implantable cardiac defibrillators are often not implanted in the first three months. It is for this reason that wearable defibrillators are sometimes used in patients with a large MI and reduced ejection fraction.
In the first year following STEMI, one-half of the sudden cardiac deaths occur.
Beyond one year, there is still an increased risk of sudden cardiac death for a prolonged period of time.

Medical Therapy to Prevent Sudden Death Following STEMI

Therapies aimed to reduce disease progression, stabilize plaque, improve left ventricular function, and reduce ischemia may minimize the risk of sudden cardiac death. These therapies include beta blockade, ACE inhibition, and statins.

Beta Blockers

Beta blocker administration has been associated with a reduction in sudden cardiac death. ^[3]. The reduction in SCD was greatest among patients with congestive heart failure.
Among patients with an ICD, beta blocker administration has been associated with an additional reduction in mortality in MADIT II and a lower frequency of ICD discharge ^[4].

ACE Inhibitor

ACE inhibitor administration has been associated with reduction in the risk of SCD.^[5] .

Angiotensin II Receptor Blockers (ARBs)

If a patient is intolerant to ACE inhibitor, an ARB can be administered.
Valsartan is non-inferior to captopril in reducing post MI mortality, and may therefore confer similar benefits in SCD ^[6].

Statin Therapy

Among patients with an ICD implanted, statin administration has been associated with a reduction in documented arrhythmias post-MI.^[7] ^[8].

Aldosterone Antagonists

In the EPHESUS trial, among the specific subgroup of post MI patients who have left ventricular dysfunction and / or diabetes, eplerenone administration was associated with reduction in all cause and SCD mortality (4.9% vs 6.1%)^[9].

Anti-arrhythmics

Despite the intuitive benefits of anti-arrhythmic treatments, antiarrhythmics have not shown a reduction in all-cause mortality in the management of post MI SCD.
Amiodarone was associated with a reduction in arrhythmic death among patients with an LVEF of <40% following STEMI, but all cause mortality was not improved in the CAMIAT ^[10] ^[11] trial.
Anti-arrhythmics such as amiodarone may be useful in reducing the frequency of shocks in patients with an ICD who have excessively frequent shocks. Flecainide and *propafenone should not be administered as these Class I C agents are proarrhythmic in patients with coronary artery disease ^[12].

Induced Hypothermia to Improve Neurological Outcome

^[13]

A systematic review by the Cochrane Collaboration suggests benefit.^[14]
A second systematic review focusing on survivors of non-shockable rhythms suggests benefit.^[15]
Patients surviving cardiac arrest who cannot follow commands or who are comatose may have increased chance of favorable neurological outcome if their body temperature is cooled to 32 to 34 degrees centigrade. ^[16] ^[17],

Prevention of Sudden Death and Implantable Cardioverter Defibrillators Following STEMI

ICD placement is indicated in those patients with a reduced left ventricular ejection fraction at 40 days post-MI and/or 3 months following revascularization (PCI or CABG) for STEMI given the survival benefits in this population.
Patients should also be treated with beta-blockers, ACE inhibitors, and statins.
Patients undergoing ICD implantation should not have a limited life expectancy due to non-cardiovascular causes.

Role of Electrophysiology Testing

Inducibiity and pharmacologic suppression of VT/VF on electrophysiologic studies is no longer deemed to be relevant based upon the MUSTT study ^[18] and the MADITT I study ^[19].
Importantly, lack of inducibility on electrophysiological testing should not preclude implantation of an ICD.

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:

Symptomatic NYHA Class III or IV congestive heart failure
A left ventricular ejection fraction < 35%
Evidence of left ventricular dyssynchrony with a QRS > 120 msec

References

↑ 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.
↑ Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA; et al. (2022). "2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death". Eur Heart J. 43 (40): 3997–4126. doi:10.1093/eurheartj/ehac262. PMID 36017572 Check |pmid= value (help).
↑ Nuttall SL, Toescu V, Kendall MJ (2000). "beta Blockade after myocardial infarction. Beta blockers have key role in reducing morbidity and mortality after infarction". BMJ (Clinical Research Ed.). 320 (7234): 581. PMC 1117610. PMID 10688573. Retrieved 2011-02-06. Unknown parameter |month= ignored (help)
↑ Brodine WN, Tung RT, Lee JK, Hockstad ES, Moss AJ, Zareba W, Hall WJ, Andrews M, McNitt S, Daubert JP (2005). "Effects of beta-blockers on implantable cardioverter defibrillator therapy and survival in the patients with ischemic cardiomyopathy (from the Multicenter Automatic Defibrillator Implantation Trial-II)". The American Journal of Cardiology. 96 (5): 691–5. doi:10.1016/j.amjcard.2005.04.046. PMID 16125497. Retrieved 2011-02-06. Unknown parameter |month= ignored (help)
↑ Domanski MJ, Exner DV, Borkowf CB, Geller NL, Rosenberg Y, Pfeffer MA (1999). "Effect of angiotensin converting enzyme inhibition on sudden cardiac death in patients following acute myocardial infarction. A meta-analysis of randomized clinical trials". Journal of the American College of Cardiology. 33 (3): 598–604. PMID 10080457. Retrieved 2011-02-06. Unknown parameter |month= ignored (help)
↑ Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Køber L, Maggioni AP, Solomon SD, Swedberg K, Van de Werf F, White H, Leimberger JD, Henis M, Edwards S, Zelenkofske S, Sellers MA, Califf RM (2003). "Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both". The New England Journal of Medicine. 349 (20): 1893–906. doi:10.1056/NEJMoa032292. PMID 14610160. Retrieved 2011-02-06. Unknown parameter |month= ignored (help)
↑ Mitchell LB, Powell JL, Gillis AM, Kehl V, Hallstrom AP (2003). "Are lipid-lowering drugs also antiarrhythmic drugs? An analysis of the Antiarrhythmics versus Implantable Defibrillators (AVID) trial". Journal of the American College of Cardiology. 42 (1): 81–7. PMID 12849664. Retrieved 2011-02-06. Unknown parameter |month= ignored (help)
↑ Dickinson MG, Ip JH, Olshansky B, Hellkamp AS, Anderson J, Poole JE, Mark DB, Lee KL, Bardy GH (2007). "Statin use was associated with reduced mortality in both ischemic and nonischemic cardiomyopathy and in patients with implantable defibrillators: mortality data and mechanistic insights from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)". American Heart Journal. 153 (4): 573–8. doi:10.1016/j.ahj.2007.02.002. PMID 17383296. Retrieved 2011-02-06. Unknown parameter |month= ignored (help)
↑ Pitt B, Remme W, Zannad F, Neaton J, Martinez F, Roniker B, Bittman R, Hurley S, Kleiman J, Gatlin M (2003). "Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction". The New England Journal of Medicine. 348 (14): 1309–21. doi:10.1056/NEJMoa030207. PMID 12668699. Retrieved 2011-02-06. Unknown parameter |month= ignored (help)
↑ Cairns JA, Connolly SJ, Roberts R, Gent M (1997). "Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Investigators". Lancet. 349 (9053): 675–82. PMID 9078198. Retrieved 2011-02-04. Unknown parameter |month= ignored (help)
↑ Farré J, Romero J, Rubio JM, Ayala R, Castro-Dorticós J (1999). "Amiodarone and "primary" prevention of sudden death: critical review of a decade of clinical trials". The American Journal of Cardiology. 83 (5B): 55D–63D. PMID 10089841. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
↑ Echt DS, Liebson PR, Mitchell LB, Peters RW, Obias-Manno D, Barker AH, Arensberg D, Baker A, Friedman L, Greene HL (1991). "Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial". The New England Journal of Medicine. 324 (12): 781–8. doi:10.1056/NEJM199103213241201. PMID 1900101. Retrieved 2011-02-07. Unknown parameter |month= ignored (help)
↑ ECC Committee, Subcommittees and Task Forces of the American Heart Association (2005). "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 112 (24 Suppl): IV1–203. doi:10.1161/CIRCULATIONAHA.105.166550. PMID 16314375.
↑ Arrich J, Holzer M, Havel C, Müllner M, Herkner H (2012). "Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation". Cochrane Database Syst Rev. 9: CD004128. doi:10.1002/14651858.CD004128.pub3. PMID 22972067.
↑ Kim YM, Yim HW, Jeong SH, Klem ML, Callaway CW (2012). "Does therapeutic hypothermia benefit adult cardiac arrest patients presenting with non-shockable initial rhythms?: A systematic review and meta-analysis of randomized and non-randomized studies". Resuscitation. 83 (2): 188–96. doi:10.1016/j.resuscitation.2011.07.031. PMID 21835145.
↑ Hypothermia after Cardiac Arrest Study Group (2002). "Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest". N Engl J Med. 346 (8): 549–56. doi:10.1056/NEJMoa012689. PMID 11856793. Review in: ACP J Club. 2002 Sep-Oct;137(2):46 Review in: Evid Based Nurs. 2002 Oct;5(4):111
↑ Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G; et al. (2002). "Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia". N Engl J Med. 346 (8): 557–63. doi:10.1056/NEJMoa003289. PMID 11856794.
↑ Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G (1999). "A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators". The New England Journal of Medicine. 341 (25): 1882–90. doi:10.1056/NEJM199912163412503. PMID 10601507. Retrieved 2011-02-06. Unknown parameter |month= ignored (help)
↑ Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, Levine JH, Saksena S, Waldo AL, Wilber D, Brown MW, Heo M (1996). "Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators". The New England Journal of Medicine. 335 (26): 1933–40. doi:10.1056/NEJM199612263352601. PMID 8960472. Retrieved 2011-02-06. Unknown parameter |month= ignored (help)

Template:WH Template:WS

[Al-KhatibStevenson2018-1] 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.

[pmid36017572-2] Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA; et al. (2022). "2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death". Eur Heart J. 43 (40): 3997–4126. doi:10.1093/eurheartj/ehac262. PMID 36017572 Check |pmid= value (help).

[pmid10688573-3] Nuttall SL, Toescu V, Kendall MJ (2000). "beta Blockade after myocardial infarction. Beta blockers have key role in reducing morbidity and mortality after infarction". BMJ (Clinical Research Ed.). 320 (7234): 581. PMC 1117610. PMID 10688573. Retrieved 2011-02-06. Unknown parameter |month= ignored (help)

[pmid16125497-4] Brodine WN, Tung RT, Lee JK, Hockstad ES, Moss AJ, Zareba W, Hall WJ, Andrews M, McNitt S, Daubert JP (2005). "Effects of beta-blockers on implantable cardioverter defibrillator therapy and survival in the patients with ischemic cardiomyopathy (from the Multicenter Automatic Defibrillator Implantation Trial-II)". The American Journal of Cardiology. 96 (5): 691–5. doi:10.1016/j.amjcard.2005.04.046. PMID 16125497. Retrieved 2011-02-06. Unknown parameter |month= ignored (help)

[pmid10080457-5] Domanski MJ, Exner DV, Borkowf CB, Geller NL, Rosenberg Y, Pfeffer MA (1999). "Effect of angiotensin converting enzyme inhibition on sudden cardiac death in patients following acute myocardial infarction. A meta-analysis of randomized clinical trials". Journal of the American College of Cardiology. 33 (3): 598–604. PMID 10080457. Retrieved 2011-02-06. Unknown parameter |month= ignored (help)

[pmid14610160-6] Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Køber L, Maggioni AP, Solomon SD, Swedberg K, Van de Werf F, White H, Leimberger JD, Henis M, Edwards S, Zelenkofske S, Sellers MA, Califf RM (2003). "Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both". The New England Journal of Medicine. 349 (20): 1893–906. doi:10.1056/NEJMoa032292. PMID 14610160. Retrieved 2011-02-06. Unknown parameter |month= ignored (help)

[pmid12849664-7] Mitchell LB, Powell JL, Gillis AM, Kehl V, Hallstrom AP (2003). "Are lipid-lowering drugs also antiarrhythmic drugs? An analysis of the Antiarrhythmics versus Implantable Defibrillators (AVID) trial". Journal of the American College of Cardiology. 42 (1): 81–7. PMID 12849664. Retrieved 2011-02-06. Unknown parameter |month= ignored (help)

[pmid17383296-8] Dickinson MG, Ip JH, Olshansky B, Hellkamp AS, Anderson J, Poole JE, Mark DB, Lee KL, Bardy GH (2007). "Statin use was associated with reduced mortality in both ischemic and nonischemic cardiomyopathy and in patients with implantable defibrillators: mortality data and mechanistic insights from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)". American Heart Journal. 153 (4): 573–8. doi:10.1016/j.ahj.2007.02.002. PMID 17383296. Retrieved 2011-02-06. Unknown parameter |month= ignored (help)

[pmid12668699-9] Pitt B, Remme W, Zannad F, Neaton J, Martinez F, Roniker B, Bittman R, Hurley S, Kleiman J, Gatlin M (2003). "Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction". The New England Journal of Medicine. 348 (14): 1309–21. doi:10.1056/NEJMoa030207. PMID 12668699. Retrieved 2011-02-06. Unknown parameter |month= ignored (help)

[pmid9078198-10] Cairns JA, Connolly SJ, Roberts R, Gent M (1997). "Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Investigators". Lancet. 349 (9053): 675–82. PMID 9078198. Retrieved 2011-02-04. Unknown parameter |month= ignored (help)

[pmid10089841-11] Farré J, Romero J, Rubio JM, Ayala R, Castro-Dorticós J (1999). "Amiodarone and "primary" prevention of sudden death: critical review of a decade of clinical trials". The American Journal of Cardiology. 83 (5B): 55D–63D. PMID 10089841. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)

[pmid1900101-12] Echt DS, Liebson PR, Mitchell LB, Peters RW, Obias-Manno D, Barker AH, Arensberg D, Baker A, Friedman L, Greene HL (1991). "Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial". The New England Journal of Medicine. 324 (12): 781–8. doi:10.1056/NEJM199103213241201. PMID 1900101. Retrieved 2011-02-07. Unknown parameter |month= ignored (help)

[pmid16314375-13] ECC Committee, Subcommittees and Task Forces of the American Heart Association (2005). "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 112 (24 Suppl): IV1–203. doi:10.1161/CIRCULATIONAHA.105.166550. PMID 16314375.

[pmid22972067-14] Arrich J, Holzer M, Havel C, Müllner M, Herkner H (2012). "Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation". Cochrane Database Syst Rev. 9: CD004128. doi:10.1002/14651858.CD004128.pub3. PMID 22972067.

[pmid21835145-15] Kim YM, Yim HW, Jeong SH, Klem ML, Callaway CW (2012). "Does therapeutic hypothermia benefit adult cardiac arrest patients presenting with non-shockable initial rhythms?: A systematic review and meta-analysis of randomized and non-randomized studies". Resuscitation. 83 (2): 188–96. doi:10.1016/j.resuscitation.2011.07.031. PMID 21835145.

[pmid11856793-16] Hypothermia after Cardiac Arrest Study Group (2002). "Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest". N Engl J Med. 346 (8): 549–56. doi:10.1056/NEJMoa012689. PMID 11856793. Review in: ACP J Club. 2002 Sep-Oct;137(2):46 Review in: Evid Based Nurs. 2002 Oct;5(4):111

[pmid11856794-17] Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G; et al. (2002). "Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia". N Engl J Med. 346 (8): 557–63. doi:10.1056/NEJMoa003289. PMID 11856794.

[pmid10601507-18] Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G (1999). "A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators". The New England Journal of Medicine. 341 (25): 1882–90. doi:10.1056/NEJM199912163412503. PMID 10601507. Retrieved 2011-02-06. Unknown parameter |month= ignored (help)

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

Latest revision as of 22:49, 23 July 2023

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

Secondary Prevention of Sudden Cardiac Death

Implantable Cardioverter Defibrillator

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

Timing of Sudden Cardiac Death Following ST-elevation MI

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

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

Wearable Defibrillators

Cardiac resynchronization therapy (CRT) Combined with ICD Placement

See also

References

Navigation menu

@@ Line 1: / Line 1: @@
-{{SI}}
+__NOTOC__
+{{Sudden cardiac death}}
+{{CMG}} {{AE}} {{Sara.Zand}} {{EdzelCo}}
-{{CMG}}
+See also [[Post cardiac arrest syndrome care pathway]]
-==Prevention of Sudden Cardiac Death==
+==Overview==
-With positive outcomes following cardiac arrest so unlikely, a great deal of effort has been spent in finding effective strategies to prevent cardiac arrest.
+*Effective measures for the [[primary prevention]] of [[sudden cardiac death]] ([[SCD]]) in individuals who are at risk of [[SCD]] but have not yet experienced an aborted [[cardiac arrest]] or [[life-threatening arrhythmias]] include [[implantable cardioverter defibrillator]] ([[ICD]]) based on the guideline.
+*[[Secondary prevention]] strategy following aborted sudden cardiac death include [[revascularization]] in patients with [[ischemic heart disease]] and  [[ICD]] implantation in patients with reduced [[left ventricular ejection fraction]] who had an experience of lethal [[arrhythmia]].
+*The optimal approach to prevention of [[SCD]] following [[ST-elevation MI]] ([[STEMI]]) has been evaluated in multiple randomized trials. In general, [[post-STEMI]] [[patients ]]should be treated with evidence-based therapies that have been associated with a reduction in [[SCD]] including [[beta-blockers]], [[ACE-inhibitors]] (or [[ARB]]s in [[patients]] who are [[ACEI]] intolerant) and [[statins]].
+*In [[patients]] who have symptomatic [[congestive heart failure]] ([[CHF]]), an [[aldosterone antagonist]] may be a reasonable additional therapy. Despite the intuitive benefits of [[antiarrhythmic]], [[amiodarone]] and [[sotalol]] have not been shown to reduce all-cause [[mortality]] following [[STEMI]], although [[amiodarone]] may be useful in reducing the frequency of [[shocks]] in [[patients]] with [[ICD]]s who have unacceptably high rates of [[shock]].
+*In general terms, [[ICD placement]] is indicated in those [[patients]] with a reduced [[left ventricular]] [[ejection fraction]] at 40 days [[post-MI]] and/or 3 months following [[revascularization]] ([[PCI]] or [[CABG]]) for [[STEMI]] given the survival benefits in this population.
-As noted above, one of the prime causes of cardiac arrest outside of hospital is [[ischemic heart disease]]. Vast resources have been put into trying to reduce cardiovascular risks across much of the developed world. In particular schemes have been put in place to promote a [[healthy diet]] and [[exercise]]. For people considered to be particularly at risk of heart disease, measures such as [[blood pressure]] control, prescription of [[cholesterol]] lowering medications, and other medico-therapeutic interventions, have been widely used. A [[magnesium deficiency (medicine)|magnesium deficiency]], or lower levels of [[magnesium]], can contribute to heart disease and a [[healthy diet]] that contains adequte [[magnesium]] may help prevent heart disease.<ref name="pmid15466951">{{cite journal |author=Rosanoff A, Seelig MS |title=Comparison of mechanism and functional effects of magnesium and statin pharmaceuticals |journal=J Am Coll Nutr |volume=23 |issue=5 |pages=501S–505S |year=2004 |month=October |pmid=15466951 |doi= |url=http://www.jacn.org/cgi/pmidlookup?view=long&pmid=15466951}}</ref> [[Magnesium]] can be used to enhance long term treatment, so it may be effective in long term prevention.<p>
+== Prevention ==
+*Effective measures for the [[primary prevention]] of [[sudden cardiac death]] in individuals who are at risk of [[SCD]] but have not yet experienced an aborted [[cardiac arrest]] or [[life-threatening arrhythmias]] include [[ICD]] implantation based on the 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]] strategy following aborted sudden cardiac death include [[revascularization]], [[ICD]] implantation.
-Patients in hospital are far less likely to have a cardiac arrest caused of primary cardiac origin, and hence present in Asystole or PEA, and have bleak outcomes. Extensive research has shown that patients in general wards often deteriorate for several hours or even days before a cardiac arrest occurs <ref name="pmid15325446">{{cite journal |author=Kause J, Smith G, Prytherch D, Parr M, Flabouris A, Hillman K |title=A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom--the ACADEMIA study |journal=Resuscitation |volume=62 |issue=3 |pages=275–82 |year=2004 |month=September |pmid=15325446 |doi=10.1016/j.resuscitation.2004.05.016 |url=}}</ref>. This has been attributed to a lack of knowledge and skill amongst ward based staff, in particular a failure to carry out measurement of the [[Respiratory rate]], which is often the major predictor of a deterioration and can often change up to 48 hours prior to a cardiac arrest. In response to this, many hospitals now have increased training for ward based staff. A number of "early warning" systems also exist which aim to quantify the risk which patients are at of deterioration based on their [[vital signs]] and thus provide a guide to staff. In addition, specialist staff are being utilised more effectively in order to augment the work already being done at ward level. These include:
+==2022 ESC Guidelines for the management of patients with ventricular arrythymias and the prevention of sudden cardiac death <ref name="pmid36017572">{{cite journal| author=Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA | display-authors=etal| title=2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. | journal=Eur Heart J | year= 2022 | volume= 43 | issue= 40 | pages= 3997-4126 | pmid=36017572 | doi=10.1093/eurheartj/ehac262 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=36017572  }} </ref>==
-* '''Crash teams''' (also known as '''Code teams''') - These are designated staff members who have particular expertise in resuscitation, who are called to the scene of all arrests within the hospital.
-* '''Medical Emergency Teams''' - These teams respond to all emergencies, with the aim of treating the patient in the acute phase of their illness in order to prevent a cardiac arrest.
-* '''Critical care outreach''' - As well as providing the services of the other two types of team, these teams are also responsible for educating non-specialist staff. In addition, they help to facilitate transfers between [[Intensive care unit|intensive care/high dependency units]] and the general hospital wards. This is particularly important, as many studies have shown that a significant percentage of patients discharged from critical care environments quickly deteriorate and are re-admitted - the outreach team offers support to ward staff to prevent this from happening.
-==Implantable cardioverter defibrillators==
+===[[Primary Prevention]] of [[Sudden Cardiac Death]]===
-A technically based intervention to prevent further cardiac arrest episodes is the use of an '''[[implantable cardioverter-defibrillator]]''' (ICD).  This device is implanted in to the patient and can offer a 'pacemaker' effect to the heart as well as acting as an instant defibrillator in the event of arrhythmia.   A recent study  by Birnie et al at the University of Ottawa Heart Institute has demonstrated that ICDs are underused in both the United States and Canada.<ref name="pmid17606938">{{cite journal |author=Birnie DH, Sambell C, Johansen H, ''et al'' |title=Use of implantable cardioverter defibrillators in Canadian and US survivors of out-of-hospital cardiac arrest |journal=CMAJ |volume=177 |issue=1 |pages=41–6 |year=2007 |month=July |pmid=17606938 |pmc=1896034 |doi=10.1503/cmaj.060730 |url=}}</ref> An accompanying editorial by Simpson  explores some of the economic, geographic, social and political reasons for this.<ref name="pmid17606939">{{cite journal |author=Simpson CS |title=Implantable cardioverter defibrillators work--so why aren't we using them? |journal=CMAJ |volume=177 |issue=1 |pages=49–51 |year=2007 |month=July |pmid=17606939 |pmc=1896028 |doi=10.1503/cmaj.070470 |url=}}</ref>
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for risk stratification and primary prevention of sudden cardiac death'''''
+|-
+| 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]])'''''
+|-
+| 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.
+|-
+| 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]])'''''
+|-
+| bgcolor="LightGreen"|
+* [[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]]).
+|-
+|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"|
+* [[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: B]])'''''
+|-
+| 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]].
+|-
+| 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]])'''''
+|-
+| bgcolor="Pink"|
+* in [[patients]] with [[CAD]], [[prophylactic treatment]] with [[anti-arrhythmic drugs]] ([[AAD]]s) other than [[beta-blockers]] is not recommended.
+|}
-==Prevention of Sudden Cardiac Death==
+{|class="wikitable"
-===ACC / AHA Guidelines- Recommendations for Implantable Cardioverter Defibrillators (DO NOT EDIT) <ref name="pmid18483207">{{cite journal |author=Epstein AE, DiMarco JP, Ellenbogen KA, ''et al'' |title=ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons |journal=Circulation |volume=117 |issue=21 |pages=e350-408 |year=2008 |month=May |pmid=18483207 |doi:10.1161/CIRCUALTIONAHA.108.189742 |url=}}</ref>===
+|-
-{{cquote|
+| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for primary prevention of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy '''''
-===Class I===
+|-
+| 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"|
+* [[ICD]] [[implantation]] should be considered in [[patients]] with definite [[arrhythmogenic right ventricular cardiomyopathy]] ([[ARVC]]) and an [[arrhythmic]] [[syncope]].
+|-
+| 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 [[patients]] with definite [[ARVC]] and severe [[RV]] or [[LV]] [[systolic dysfunction]].
+|-
+|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 [[symptomatic]] [[patients]] with definite [[ARVC]], moderate right or left [[ventricular dysfunction]], and either [[NSVT]] or inducibility of [[SMVT]] at [[PES]].
+|-
+| 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="LemonChiffon"|
+* In [[patients]] with [[ARVC]] and [[symptoms]] highly suspicious for [[VA]], [[PES]] may be considered for [[risk stratification]].
+|}
-. [[ICD therapy]] is indicated in patients who are survivors of [[cardiac arrest]] due to [[VF]] or hemodynamically unstable sustained [[VT]] after evaluation to define the cause of the event and to exclude any completely reversible causes. (Level of Evidence: A)
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for risk stratification and primary prevention of sudden cardiac death'''''
+|-
+| 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]])'''''
+|-
+| 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.
+|-
+| 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]])'''''
+|-
+| bgcolor="LightGreen"|
+* [[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]]).
+|-
+|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"|
+* [[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: B]])'''''
+|-
+| 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]].
+|-
+| 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]])'''''
+|-
+| bgcolor="Pink"|
+* in [[patients]] with [[CAD]], [[prophylactic treatment]] with [[anti-arrhythmic drugs]] ([[AAD]]s) other than [[beta-blockers]] is not recommended.
+|}
-. [[ICD therapy]] is indicated in patients with structural [[heart disease]] and spontaneous sustained [[VT]], whether hemodynamically stable or unstable. (Level of Evidence: B)
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for risk stratification and primary prevention of sudden cardiac death 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: C]])'''''
+|-
+| bgcolor="LightGreen"|
+* 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.
+|-
+| 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]])'''''
+|-
+| 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]])'''''
+|-
+| bgcolor="LemonChiffon"|
+* [[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]].
+|-
+| 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 [[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.
+|-
+| 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"|
+* [[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%.
+|-
+| 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"|
+* [[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]].
+|}
-. [[ICD therapy]] is indicated in patients with [[syncope]] of undetermined origin with clinically relevant, hemodynamically significant sustained [[VT]] or [[VF]] induced at electrophysiological study. (Level of Evidence: B)
+===[[Secondary Prevention]] of [[Sudden Cardiac Death]]===
-. [[ICD therapy]] is indicated in patients with [[LVEF]] less than 35% due to prior [[MI]] who are at least 40 days post-MI and are in NYHA functional Class II or III. (Level of Evidence: A)
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for secondary prevention of sudden cardiac death and treatment of ventricular arrhythmias'''''
+|-
+| 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]])'''''
+|-
+| bgcolor="LightGreen"|
+* [[ICD]] implantation is recommended in [[patients]] without ongoing [ischemia]] with documented [[ventricular fibrillation]] or [[hemodynamically]] not-tolerated [[ventricular tachycardia]] occurring after than 48 hours after [[myocardial infarction]].
+|-
+| 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"|
+* In [[patients]] with [[coronary artery disease]] ([[CAD]]) and recurrent, [[symptomatic]] [[SMVT]] or [[ICD]] shocks for [[SMVT]] despite [[chronic]] [[amiodarone]] [[therapy]], [[catheter ablation]] is recommended in preference to escalating [[anti-arrhythmic drug]] [[therapy]].
+|-
+|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"|
+* The addition of [[oral]] [[amiodarone]] or [[beta-blocker]] replacement by [[sotalol]] should be considered in [[patients]] with [[coronary artery disease]] ([[CAD]]) with [[recurrent]], [[symptomatic]] [[SMVT]], or [[ICD]] shocks for [[SMVT]] while on [[beta-blocker]] [[treatment]].
+|-
+| 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 [[CAD]] and [[hemodynamically]] well-tolerated [[SMVT]] and [[LVEF]] greater than or equal to 40%, [[catheter ablation]] in experienced centers should be considered as an alternative to [[ICD]] [[therapy]], provided that established endpoints have been reached.
+|-
+| 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 [[patients]] with a [[hemodynamically]] tolerated [[SMVT]] and an [[LVEF]] greater than or equal to 40% if [[VT]] [[ablation]] fails, is not available, or is not desired.
+|-
+| 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"|
+* [[Catheter ablation]] should be considered in [[patients]] with [[CAD]] and [[recurrent]], [[symptomatic]] [[SMVT]], or [[ICD]] shocks for [[SMVT]] despite [[beta-blockers]] or [[sotalol]] [[treatment]].
+|-
+| 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"|
+* In [[patients]] with [[CAD]] eligible for [[ICD]] [[implantation]], [[catheter ablation]] may be considered just before (or immediately after) [[ICD]] [[implantation]] to decrease subsequent [[VT]] burden and [[ICD]] shocks.
+|}
-. [[ICD therapy]] is indicated in patients with [[nonischemic DCM]] who have an [[LVEF]] less than or equal to 35% and who are in NYHA functional Class II or III. (Level of Evidence: B)
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for secondary prevention of sudden cardiac death and treatment of ventricular arrhythmias'''''
+|-
+| 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 [[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]])'''''
+|-
+| bgcolor="LemonChiffon"|
+* [[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.
+|-
+|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"|
+* 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]].
+|-
+| 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 [[patients]] with [[DCM]]/[[HNDCM]] and [[hemodynamically]] tolerated [[SMVT]].
+|}
-. [[ICD therapy]] is indicated in patients with [[LV dysfunction]] due to prior [[MI]] who are at least 40 days post-MI, have an [[LVEF]] less than 30%, and are in NYHA functional Class I. (Level of Evidence: A)
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for secondary prevention of sudden cardiac death and treatment of ventricular arrhythmias in ARVC'''''
+|-
+| 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]])'''''
+|-
+| 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.
+|}
-. [[ICD therapy]] is indicated in patients with [[nonsustained VT]] due to prior [[MI]], [[LVEF]] less than 40%, and [[inducible VF]] or [[sustained VT]] at electrophysiological study. (Level of Evidence: B)
+{|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.
+|}
-===Class IIa===
+====Implantable Cardioverter Defibrillator====
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for implantable cardioverter defibrillator implantation (general aspects)'''''
+|-
+| 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]])'''''
+|-
+| bgcolor="LightGreen"|
+* [[Implantation]] of a [[cardioverter defibrillator]] is only recommended in [[patients]] who have an expectation of good quality [[survival]] > 1 year.
+|-
+| 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"|
+* It is not recommended to [[implant]] an [[ICD]] in [[patients]] with incessant [[ventricular arrhythmia's]] ([[VA]]s) until the [[VA]] is controlled.
+|}
-. [[ICD implantation]] is reasonable for patients with unexplained [[syncope]], significant [[LV dysfunction]], and [[nonischemic DCM]]. (Level of Evidence: C)
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for subcutaneous implantable cardioverter defibrillator'''''
+|-
+| 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"|
+* [[Subcutaneous]] [[defibrillator]] should be considered as an alternative to [[transvenous defibrillator]] in [[patients]] with an [[indication]] for an [[ICD]] when [[pacing therapy]] for [[bradycardia]], [[cardiac resynchronization]], or [[anti-tachycardia pacing]] ([[ATP]]) is not needed.
+|-
+| 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"|
+* It is not recommended to [[implant]] an [[ICD]] in [[patients]] with incessant [[ventricular arrhythmia's]] ([[VA]]s) until the [[VA]] is controlled.
+|}
-. [[ICD implantation]] is reasonable for patients with [[sustained VT]] and normal or near-normal [[ventricular function]]. (Level of Evidence: C)
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for implantable cardioverter defibrillator implantation in left ventricular non-compaction'''''
+|-
+| 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 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.
+|}
-. [[ICD implantation]] is reasonable for patients with [[HCM]] who have 1 or more major{dagger} risk factors for [[SCD]]. (Level of Evidence: C)
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for implantable cardioverter defibrillator implantation in patients with cardiac amyloidosis'''''
+|-
+| 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"|
+* An [[ICD]] should be considered in [[patients]] with [[light-chain amyloidosis]] or [[transthyretin-associated cardiac amyloidosis]] and [[hemodynamically]] not-tolerated [[VT]].
+|}
-. [[ICD implantation]] is reasonable for the prevention of [[SCD]] in patients with [[ARVD/C]] who have 1 or more risk factors for [[SCD]]. (Level of Evidence: C)
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background: Silver"|'''Recommendation for diagnosis and management of ventricular arryhthmia in neuromuscular diseases'''''
+|-
+| 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]])'''''
+|-
+| bgcolor="LightGreen"|
+* [[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]])'''''
+|-
+| 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]])'''''
+|-
+| 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]])'''''
+|-
+| bgcolor="LemonChiffon"|
+* [[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]].
+|-
+| 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]] 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]])'''''
+|-
+| 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]].
+|}
-. [[ICD implantation]] is reasonable to reduce [[SCD]] in patients with [[long-QT syndrome]] who are experiencing [[syncope]] and/or [[VT]] while receiving [[beta blockers]]. (Level of Evidence: B)
+==2017AHA/ACC/HRS Guideline for management of [[sudden cardiac arrest]] and [[ventricular arrhythmia]]==
+<span style="font-size:85%">'''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]]
+</span>
+<br>
-. [[ICD implantation]] is reasonable for non hospitalized patients awaiting [[transplant]]ation. (Level of Evidence: C)
+{| style="cellpadding=0; cellspacing= 0; width: 600px;"
+|-
+| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Recommendations for primary prevention of sudden cardiac death in ischemic heart disease'''
+|-
+|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | '''[[ICD]] implantation  ([[ACC AHA guidelines classification scheme|Class I, Level of Evidence A]]):'''
+|-
+|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
+❑ 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 <br
+❑ In patients with [[LVEF]]≤ 30% and [[NYHA]] class 1 [[heart failure]] despite medical therapy at least 40 days post [[MI]] or 90 days [[postrevascularization]] with life expectancy > 1 year
+|-
+|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 [[LVEF]] ≤ 40% and nonsustained [[VT]] due to prior [[MI]] or [[VT]] ,[[VF]] inducible in [[EPS]] with life expectancy >1 year<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 patients with [[NYHA]] class 4 who are candidates for cardiac transplantation or [[LVAD]] with life expectancy > 1 year
+|-
+|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''([[ACC AHA guidelines classification scheme|Class III, Level of Evidence C]])'''
+|-
+|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
+❑ [[ICD ]] is not beneficial in patients with [[NYHA]] class 4 despite optimal medical therapy who are not candidates for [[cardiac transplantation]] or [[LVAD]]
+|-
+|}
-. [[ICD implantation]] is reasonable for patients with [[Brugada syndrome]] who have had [[syncope]]. (Level of Evidence: C)
-. [[ICD implantation]] is reasonable for patients with [[Brugada syndrome]] who have documented [[VT]] that has not resulted in [[cardiac arrest]]. (Level of Evidence: C)
-. [[ICD implantation]] is reasonable for patients with [[catecholaminergic polymorphic VT]] who have syncope and/or documented sustained [[VT]] while receiving [[beta blockers]]. (Level of Evidence: C)
+{{Family tree/start}}
+{{Family tree | | | | | | | A01 | | | | A01=Secondary prevention in patients with [[IHD]]}}
+{{Family tree | | | | |,|-|-|^|-|-|.| | }}
+{{Family tree | | | | B01 | | | | B02 | | |B01=[[SCA]] survivor or sustained monomorph [[VT]]|B02=Cardiac [[syncope]]}}
+{{Family tree | | | | |!| | | | | |!| | | | | | | | |}}
+{{Family tree | | | | C01 | | | | C02 |-|-|-|.| | | | | |C01=[[Ischemia]]|C02=LVEF≤35%}}
+{{Family tree | | |,|-|^|-|.| | | | | | | | |!| | | |}}
+{{Family tree | | |D01| |D02| | | | | | |!| | | | | | | |D01=Yes: [[revascularization]], reassessment about [[SCD]] risk (class1)|D02=NO:[[ICD]] candidate}}
+{{Family tree | | | | |,|-|^|-|.| | | | |,|-|^|-|.| |}}
+{{Family tree | | | | |E01| |E02| | | D03 | | D04 | | | | E01=Yes:[[ICD]] (class1)|E02=NO: medical therapy (class1)|D03= Yes:[[ICD]] (CLASS1)| D04=NO:[[EP study]] (class 2a)}}
+{{Family tree | | | | | | | | | | | | | | | | | |!| |}}
+{{Family tree | | | | | | | | | | | | | | | | | E03 | |E03=[[Ventriculat arrhythmia]] induction}}
+{{Family tree | | | | | | | | | | | | | | | |,|-|^|-|.| |}}
+{{Family tree | | | | | | | | | | | | | | | |F01| |F02| |F01=Yes: [[ICD]] (class1)|F02=NO: monitoring }}
+{{Family tree | | | | | | | | | | | | | | | | | | | |}}
+{{Family tree | | | | | | | | | | | | | | | | | | | |}}
+{{Family tree | | | | | | | | | | | | | | | | | | | |}}
+{{Family tree | | | | | | | | | | | | | | | | | | | |}}
+{{Family tree | | | | | | | | | | | | | | | | | | | |}}
+{{Family tree | | | | | | | | | | | | | | | | | | | |}}
+{{Family tree/end}}
-. [[ICD implantation]] is reasonable for patients with [[cardiac sarcoidosis]], [[giant cell myocarditis]], or [[Chagas disease]]. (Level of Evidence: C)
-===Class IIb===
-. [[ICD therapy]] may be considered in patients with nonischemic [[heart disease]] who have an [[LVEF]] of less than or equal to 35% and who are in NYHA functional Class I. (Level of Evidence: C)
+===Timing of [[Sudden Cardiac Death]] Following [[ST-elevation MI]] ===
+[[Patients]] with [[STEMI]] are at risk of s[[udden cardiac death]]. The timing of [[sudden cardiac death]] following [[STEMI]] is as follows:
+* In the first 3 months after [[STEMI]], one-quarter of [[sudden cardiac deaths]] occur. This statistic is critical in so far as [[implantable cardiac defibrillators]] are often not implanted in the first three months. It is for this reason that wearable [[defibrillators]] are sometimes used in patients with a large [[MI]] and reduced [[ejection fraction]].
+* In the first year following [[STEMI]], one-half of the [[sudden cardiac deaths]] occur.
+* Beyond one year, there is still an increased risk of [[sudden cardiac death]] for a prolonged period of time.
-. [[ICD therapy]] may be considered for patients with [[long-QT syndrome]] and risk factors for [[SCD]]. (Level of Evidence: B)
+===Medical Therapy to Prevent Sudden Death Following STEMI===
-. [[ICD therapy]] may be considered in patients with [[syncope]] and advanced structural heart disease in whom thorough invasive and noninvasive investigations have failed to define a cause. (Level of Evidence: C)
+*Therapies aimed to reduce disease progression, stabilize plaque, improve [[left ventricular function]], and reduce [[ischemia]] may minimize the risk of [[sudden cardiac death]]. These therapies include [[beta blockade]], [[ACE inhibition]], and [[statins]].
-. [[ICD therapy]] may be considered in patients with a [[familial cardiomyopathy]] associated with sudden death. (Level of Evidence: C)
+====[[Beta Blockers]]====
-. [[ICD therapy]] may be considered in patients with [[LV]] noncompaction. (Level of Evidence: C)
+*[[Beta blocker]] administration has been associated with a reduction in [[sudden cardiac death]]. <ref name="pmid10688573">{{cite journal | author = Nuttall SL, Toescu V, Kendall MJ | title = beta Blockade after myocardial infarction. Beta blockers have key role in reducing morbidity and mortality after infarction | journal = [[BMJ (Clinical Research Ed.)]] | volume = 320 | issue = 7234 | pages = 581 | year = 2000 | month = February | pmid = 10688573 | pmc = 1117610 | doi = | url = http://bmj.com/cgi/pmidlookup?view=long&pmid=10688573 | issn = | accessdate = 2011-02-06}}</ref>.  The reduction in SCD was greatest among patients with [[congestive heart failure]].
+*Among patients with an [[ICD]], [[beta blocker]] administration has been associated with an additional reduction in mortality in MADIT II  and a lower frequency of [[ICD]] discharge  <ref name="pmid16125497">{{cite journal | author = Brodine WN, Tung RT, Lee JK, Hockstad ES, Moss AJ, Zareba W, Hall WJ, Andrews M, McNitt S, Daubert JP | title = Effects of beta-blockers on implantable cardioverter defibrillator therapy and survival in the patients with ischemic cardiomyopathy (from the Multicenter Automatic Defibrillator Implantation Trial-II) | journal = [[The American Journal of Cardiology]] | volume = 96 | issue = 5 | pages = 691–5 | year = 2005 | month = September | pmid = 16125497 | doi = 10.1016/j.amjcard.2005.04.046 | url = http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(05)00942-2 | issn = | accessdate = 2011-02-06}}</ref>.
-===Class III===
+====[[ACE Inhibitor]]====
+*[[ACE inhibitor]] administration has been associated with reduction in the risk of [[SCD]].<ref name="pmid10080457">{{cite journal | author = Domanski MJ, Exner DV, Borkowf CB, Geller NL, Rosenberg Y, Pfeffer MA | title = Effect of angiotensin converting enzyme inhibition on sudden cardiac death in patients following acute myocardial infarction. A meta-analysis of randomized clinical trials | journal = [[Journal of the American College of Cardiology]] | volume = 33 | issue = 3 | pages = 598–604 | year = 1999 | month = March | pmid = 10080457 | doi = | url = http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(98)00609-3 | issn = | accessdate = 2011-02-06}}</ref> .
-. [[ICD therapy]] is not indicated for patients who do not have a reasonable expectation of survival with an acceptable functional status for at least 1 year, even if they meet [[ICD implantation]] criteria specified in the Class I, IIa, and IIb recommendations above. (Level of Evidence: C)
+====Angiotensin II Receptor Blockers (ARBs)====
+*If a patient is intolerant to [[ACE inhibitor]], an [[ARB]] can be administered.
+*[[Valsartan]] is non-inferior to [[captopril]] in reducing [[post MI mortality]], and may therefore confer similar benefits in [[SCD]] <ref name="pmid14610160">{{cite journal | author = Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Køber L, Maggioni AP, Solomon SD, Swedberg K, Van de Werf F, White H, Leimberger JD, Henis M, Edwards S, Zelenkofske S, Sellers MA, Califf RM | title = Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both | journal = [[The New England Journal of Medicine]] | volume = 349 | issue = 20 | pages = 1893–906 | year = 2003 | month = November | pmid = 14610160 | doi = 10.1056/NEJMoa032292 | url = http://dx.doi.org/10.1056/NEJMoa032292 | issn = | accessdate = 2011-02-06}}</ref>.
-. [[ICD therapy]] is not indicated for patients with incessant [[VT]] or [[VF]]. (Level of Evidence: C)
+====[[Statin]] Therapy====
+*Among patients with an [[ICD]] implanted, [[statin]] administration has been associated with a reduction in documented [[arrhythmias]] [[post-MI]].<ref name="pmid12849664">{{cite journal | author = Mitchell LB, Powell JL, Gillis AM, Kehl V, Hallstrom AP | title = Are lipid-lowering drugs also antiarrhythmic drugs? An analysis of the Antiarrhythmics versus Implantable Defibrillators (AVID) trial | journal = [[Journal of the American College of Cardiology]] | volume = 42 | issue = 1 | pages = 81–7 | year = 2003 | month = July | pmid = 12849664 | doi = | url = http://linkinghub.elsevier.com/retrieve/pii/S0735109703004984 | issn = | accessdate = 2011-02-06}}</ref> <ref name="pmid17383296">{{cite journal | author = Dickinson MG, Ip JH, Olshansky B, Hellkamp AS, Anderson J, Poole JE, Mark DB, Lee KL, Bardy GH | title = Statin use was associated with reduced mortality in both ischemic and nonischemic cardiomyopathy and in patients with implantable defibrillators: mortality data and mechanistic insights from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) | journal = [[American Heart Journal]] | volume = 153 | issue = 4 | pages = 573–8 | year = 2007 | month = April | pmid = 17383296 | doi = 10.1016/j.ahj.2007.02.002 | url = http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(07)00122-6 | issn = | accessdate = 2011-02-06}}</ref>.
-. [[ICD therapy]] is not indicated in patients with significant [[psychiatric illness]]es that may be aggravated by device implantation or that may preclude systematic follow-up. (Level of Evidence: C)
+====[[Aldosterone Antagonists]]====
+*In the [[EPHESUS trial]], among the specific subgroup of post [[MI]] patients who have [[left ventricular]] dysfunction and / or [[diabetes]], [[eplerenone]] administration was associated with reduction in all cause and [[SCD]] mortality (4.9% vs 6.1%)<ref name="pmid12668699">{{cite journal | author = Pitt B, Remme W, Zannad F, Neaton J, Martinez F, Roniker B, Bittman R, Hurley S, Kleiman J, Gatlin M | title = Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction | journal = [[The New England Journal of Medicine]] | volume = 348 | issue = 14 | pages = 1309–21 | year = 2003 | month = April | pmid = 12668699 | doi = 10.1056/NEJMoa030207 | url = http://dx.doi.org/10.1056/NEJMoa030207 | issn = | accessdate = 2011-02-06}}</ref>.
-. [[ICD therapy]] is not indicated for NYHA Class IV patients with [[drug-refractory congestive heart failure]] who are not candidates for [[cardiac transplantation]] or [[CRT-D]]. (Level of Evidence: C)
+====[[Anti-arrhythmics]]====
+*Despite the intuitive benefits of anti-arrhythmic treatments, [[antiarrhythmics]] have not shown a reduction in all-cause mortality in the management of post [[MI]] [[SCD]].
+*[[Amiodarone]] was associated with a reduction in [[arrhythmic]] [[death]] among [[patients]] with an [[LVEF]] of <40% following [[STEMI]], but [[all cause mortality]] was not improved in the CAMIAT <ref name="pmid9078198">{{cite journal | author = Cairns JA, Connolly SJ, Roberts R, Gent M | title = Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Investigators | journal = [[Lancet]] | volume = 349 | issue = 9053 | pages = 675–82 | year = 1997 | month = March | pmid = 9078198 | doi = | url = http://linkinghub.elsevier.com/retrieve/pii/S0140673696081718 | issn = | accessdate = 2011-02-04}}</ref> <ref name="pmid10089841">{{cite journal | author = Farré J, Romero J, Rubio JM, Ayala R, Castro-Dorticós J | title = Amiodarone and "primary" prevention of sudden death: critical review of a decade of clinical trials | journal = [[The American Journal of Cardiology]] | volume = 83 | issue = 5B | pages = 55D–63D | year = 1999 | month = March | pmid = 10089841 | doi = | url = | issn = | accessdate = 2011-02-04}}</ref> trial.
+*[[ Anti-arrhythmics]] such as [[amiodarone]] may be useful in reducing the frequency of [[shocks]] in [[patients]] with an [[ICD]] who have excessively frequent [[shocks]]. [[Flecainide]] and *[[propafenone]] should not be administered  as these Class I C agents are [[proarrhythmic]] in [[patients]] with [[coronary artery disease]] <ref name="pmid1900101">{{cite journal | author = Echt DS, Liebson PR, Mitchell LB, Peters RW, Obias-Manno D, Barker AH, Arensberg D, Baker A, Friedman L, Greene HL | title = Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial | journal = [[The New England Journal of Medicine]] | volume = 324 | issue = 12 | pages = 781–8 | year = 1991 | month = March | pmid = 1900101 | doi = 10.1056/NEJM199103213241201 | url = http://dx.doi.org/10.1056/NEJM199103213241201 | issn = | accessdate = 2011-02-07}}</ref>.
-. [[ICD therapy]] is not indicated for [[syncope]] of undetermined cause in a patient without [[inducible ventricular tachyarrhythmias]] and without structural [[heart disease]]. (Level of Evidence: C)
+===Induced [[Hypothermia]] to Improve [[Neurological]] Outcome===
+<ref name="pmid16314375">{{cite journal| author=ECC Committee, Subcommittees and Task Forces of the American Heart Association| title=2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. | journal=Circulation | year= 2005 | volume= 112 | issue= 24 Suppl | pages= IV1-203 | pmid=16314375 | doi=10.1161/CIRCULATIONAHA.105.166550 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16314375  }} </ref>
-. [[ICD therapy]] is not indicated when [[VF]] or [[VT]] is amenable to surgical or catheter ablation (e.g., [[atrial arrhythmias]] associated with the [[Wolff-Parkinson-White syndrome]], [[RV]] or [[LV]] [[outflow tract VT]], [[idiopathic VT]], or [[fascicular VT]] in the absence of structural [[heart disease]]). (Level of Evidence: C)
+*A [[systematic review]] by the [[Cochrane Collaboration]] suggests benefit.<ref name="pmid22972067">{{cite journal| author=Arrich J, Holzer M, Havel C, Müllner M, Herkner H| title=Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. | journal=Cochrane Database Syst Rev | year= 2012 | volume= 9 | issue=  | pages= CD004128 | pmid=22972067 | doi=10.1002/14651858.CD004128.pub3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22972067  }} </ref>
+*A second [[systematic review]] focusing on survivors of [[non-shockable rhythms]] suggests benefit.<ref name="pmid21835145">{{cite journal| author=Kim YM, Yim HW, Jeong SH, Klem ML, Callaway CW| title=Does therapeutic hypothermia benefit adult cardiac arrest patients presenting with non-shockable initial rhythms?: A systematic review and meta-analysis of randomized and non-randomized studies. | journal=Resuscitation | year= 2012 | volume= 83 | issue= 2 | pages= 188-96 | pmid=21835145 | doi=10.1016/j.resuscitation.2011.07.031 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21835145  }} </ref>
+*[[Patients]] surviving [[cardiac arrest]] who cannot follow commands or who are comatose may have increased chance of favorable [[neurological outcome]] if their [[body]] [[temperature]] is cooled to 32 to 34 degrees centigrade. <ref name="pmid11856793">{{cite journal| author=Hypothermia after Cardiac Arrest Study Group| title=Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 8 | pages= 549-56 | pmid=11856793 | doi=10.1056/NEJMoa012689 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11856793  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12207424 Review in: ACP J Club. 2002 Sep-Oct;137(2):46]  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12402814 Review in: Evid Based Nurs. 2002 Oct;5(4):111] </ref> <ref name="pmid11856794">{{cite journal| author=Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G et al.| title=Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 8 | pages= 557-63 | pmid=11856794 | doi=10.1056/NEJMoa003289 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11856794  }} </ref>,
-. [[ICD therapy]] is not indicated for patients with [[ventricular tachyarrhythmias]] due to a completely reversible disorder in the absence of structural [[heart disease]] (e.g., [[electrolyte imbalance]], [[drugs]], or [[trauma]]). (Level of Evidence: B)}}
+===Prevention of [[Sudden Death]] and [[Implantable Cardioverter Defibrillators]] Following [[STEMI]]===
+* [[ICD]] placement is indicated in those patients with a reduced [[left ventricular ejection fraction]] at 40 days post-MI and/or 3 months following [[revascularization]] ([[PCI]] or [[CABG]]) for [[STEMI]] given the [[survival]] benefits in this population.
+* [[Patients]] should also be treated with [[beta-blockers]], [[ACE inhibitors]], and [[statins]].
+* Patients undergoing [[ICD]] implantation should not have a limited life expectancy due to non-[[cardiovascular]] causes.
+====Role of [[Electrophysiology]] Testing====
+*Inducibiity and pharmacologic suppression of [[VT]]/[[VF]] on [[electrophysiologic]] studies is no longer deemed to be relevant based upon the [[MUSTT]] study <ref name="pmid10601507">{{cite journal | author = Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G | title = A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators | journal = [[The New England Journal of Medicine]] | volume = 341 | issue = 25 | pages = 1882–90 | year = 1999 | month = December | pmid = 10601507 | doi = 10.1056/NEJM199912163412503 | url = http://dx.doi.org/10.1056/NEJM199912163412503 | issn = | accessdate = 2011-02-06}}</ref> and the MADITT I study <ref name="pmid8960472">{{cite journal | author = Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, Levine JH, Saksena S, Waldo AL, Wilber D, Brown MW, Heo M | title = Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators | journal = [[The New England Journal of Medicine]] | volume = 335 | issue = 26 | pages = 1933–40 | year = 1996 | month = December | pmid = 8960472 | doi = 10.1056/NEJM199612263352601 | url = http://dx.doi.org/10.1056/NEJM199612263352601 | issn = | accessdate = 2011-02-06}}</ref>.
+*Importantly, lack of inducibility on [[electrophysiological]] testing should not preclude implantation of an [[ICD]].
-===ACC / AHA Guidelines- Recommendations for Implantable Cardioverter-Defibrillators in Pediatric Patients and Patients With Congenital Heart Disease (DO NOT EDIT) <ref name="pmid18483207">{{cite journal |author=Epstein AE, DiMarco JP, Ellenbogen KA, ''et al'' |title=ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons |journal=Circulation |volume=117 |issue=21 |pages=e350-408 |year=2008 |month=May |pmid=18483207 |doi:10.1161/CIRCUALTIONAHA.108.189742 |url=}}</ref>===
+===The Benefit of [[ICD]] Implantation May Be Greater in Patients with a [[QRS]] Duration > 120 msec===
-{{cquote|
-===Class I===
-. [[ICD implantation]] is indicated in the survivor of [[cardiac arrest]] after evaluation to define the cause of the event and to exclude any reversible causes. (Level of Evidence: B)
+*In both SCD-HeFT and MADIT II, the reduction in [[SCD]] was greater in patients with a [[QRS]] duration > 120 msec.
-. [[ICD implantation]] is indicated for patients with [[symptomatic sustained VT]] in association with [[congenital heart disease]] who have undergone hemodynamic and electrophysiological evaluation. [[Catheter ablation]] or surgical repair may offer possible alternatives in carefully selected patients. (Level of Evidence: C)
+===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.
-===Class IIa===
+===[[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:
+* Symptomatic NYHA Class III or IV congestive [[heart failure]]
+* A [[left ventricular]] [[ejection fraction]] <u><</u> 35%
+* Evidence of [[left ventricular]] dyssynchrony with a [[QRS]] > 120 msec
-. [[ICD implantation]] is reasonable for patients with [[congenital heart disease]] with [[recurrent syncope]] of undetermined origin in the presence of either [[ventricular dysfunction]] or [[inducible ventricular arrhythmia]]s at electrophysiological study. (Level of Evidence: B)
+==See also==
-===Class IIb===
+* [[Sudden cardiac death]]
+* [[Sudden cardiac death post arrest care and prevention]]
+* [[Post cardiac arrest syndrome care pathway]]
+* [[Therapeutic hypothermia]]
-. [[ICD implantation]] may be considered for patients with [[recurrent syncope]] associated with complex [[congenital heart disease]] and [[advanced systemic ventricular dysfunction]] when thorough invasive and noninvasive investigations have failed to define a cause. (Level of Evidence: C)
+==References==
-===Class III===
-. All Class III recommendations found in Section 3, "Indications for Implantable Cardioverter-Defibrillator Therapy," apply to pediatric patients and patients with [[congenital heart disease]], and [[ICD implantation]] is not indicated in these patient populations. (Level of Evidence: C) }}
-==References==
 {{reflist|2}}
-[[Category:Cardiology]]
-[[Category:Emergency medicine]]
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Sudden cardiac death post arrest care and prevention: Difference between revisions

Latest revision as of 22:49, 23 July 2023

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

Secondary Prevention of Sudden Cardiac Death

Implantable Cardioverter Defibrillator

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

Timing of Sudden Cardiac Death Following ST-elevation MI

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

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

Wearable Defibrillators

Cardiac resynchronization therapy (CRT) Combined with ICD Placement

See also

References

Navigation menu

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