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

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{{SI}}
__NOTOC__
{{Sudden cardiac death}}
{{CMG}} {{AE}} {{Sara.Zand}} {{EdzelCo}}


{{CMG}}
See also [[Post cardiac arrest syndrome care pathway]]


{{EJ}}
==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 [[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.


==Timing of Sudden Cardiac Death Following ST elevation MI ==
== 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 with STEMI are at risk of sudden cardiac death. The timing of sudden cardiac death following STEMI is as follows:
==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>==


* 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]].
===[[Primary Prevention]] of [[Sudden Cardiac Death]]===
{|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.
|}


* In the first year following STEMI one half of the sudden cardiac deaths occur.
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for primary prevention of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy '''''
|-
| 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]].  
|}


* Beyond one year, there is still an increased risk of sudden cardiac death for a prolonged period of time.
{|class="wikitable"
==Medical Therapy to Prevent Sudden Death Following STEMI==
|-
| 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.
|}


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]].
{|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]].
|}


===Beta Blockers===
===[[Secondary Prevention]] of [[Sudden Cardiac Death]]===


[[Beta blocker]] administration has been associated with a reduction in sudden cardiac death from  5.0% to 3.3% in a review of 13 trials <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 (hazard ratio of 0.42 to 0.44) and a lower frequency of ICD discharge (hazard ratio of 0.48) <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="wikitable"
===ACE inhibition===
|-
| 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.
|}


[[ACE inhibitor]] administration has been associated with a 20% relative and a 1.4% absolute reduction in the risk of SCD in a metanalysis of randomized trials<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> .
{|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]].
|}


===Angiotensin II receptor blockers (ARBs)===
{|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.
|}


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>. 
{|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.
|}


===Statin Therapy===
====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.
|}


Among patients with an ICD implanted, statin administration has been associated with a reduction in documented arrhythmias post-MI in observation studies <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>.
{|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.
|}


===Aldosterone antagonists===
{|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.
|}


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>.
{|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]].
|}


==Anti-arrhythmics==
{|class="wikitable"
* Despite the intuitive benefits of anti-arrhythmic treatments, anti-arrhythmics have not shown a reduction in all cause mortality in the management of post MI SCD.
|-
* Anti-arrhythmics may be useful in reducing the frequency of shocks in patients with an ICD.
| colspan="1" style="text-align:center; background: Silver"|'''Recommendation for diagnosis and management of ventricular arryhthmia in neuromuscular diseases'''''
* 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.
|-
| 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]].
|}


==Prevention of Sudden Death and Implantable Cardioverter Defibrillators Following STEMI==
==2017AHA/ACC/HRS Guideline for management of [[sudden cardiac arrest]] and [[ventricular arrhythmia]]==
===Overview===
<span style="font-size:85%">'''Abbreviations:'''
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.  Patients should also be treated with evidence based therapies including beta-blockers, ACE inhibitors and statins.  Patients undergoing ICD implantation should not have a limited life expectancy due to non-cardiovascular causes.
'''MI:''' [[Myocardial infarction]];
===Grade 1 Consensus Guideline Recommendations Regarding ICD Placement===
'''VT:''' [[Ventricular tachycardia]];
The following are clear Grade 1 A recommendations for placement of an ICD:
'''VF:''' [[Ventricular fibrillation]];
* Based upon the MADIT II study entry criteria, patients with a prior MI and an LVEF of <u><</u> 30% should be treated with an ICD after 40 days. This is true whether or not the patient is inducible on electrophysiologic testing.
'''LVEF:''' [[Left ventricular ejection fraction]];
* Based upon the SCD-Heft study entry criteria, patients who are symptomatic NYHA grade II or III CHF with an LVEF <u><</u> 35%. Again, This is true whether or not the patient is inducible on electrophysiologic testing.
'''ICD:''' [[Implantable cardioverter defibrillator]];
* Some patients will not have an LVEF as low as <u><</u> 30% as in MADIT II or as low as an LVEF <u><</u> 35% as in SCD-HeFT, but if they have an LVEF <u><</u> 40%, and non sustained ventricular tachycardia on Holter monitoring and are inducible on EP testing, then they are appropriate candidates for ICD placement based upon the MUSTT and MADIT I trials.
'''NYHA:''' [[New York Heart Association]] functional classification;
'''LVAD:''' [[Left ventricular assist device]];
'''EPS:''' [[Electrophysiology study]]
</span>
<br>


===Timing of ICD Placement===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
Despite the fact that the highest risk of SCD is in the first 3 months after STEMI, the DINAMIT <ref name="pmid15590950">{{cite journal | author = Hohnloser SH, Kuck KH, Dorian P, Roberts RS, Hampton JR, Hatala R, Fain E, Gent M, Connolly SJ | title = Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction | journal = [[The New England Journal of Medicine]] | volume = 351 | issue = 24 | pages = 2481–8 | year = 2004 | month = December | pmid = 15590950 | doi = 10.1056/NEJMoa041489 | url = http://dx.doi.org/10.1056/NEJMoa041489 | issn = | accessdate = 2011-02-04}}</ref> and IRIS <ref name="pmid19812399">{{cite journal | author = Steinbeck G, Andresen D, Seidl K, Brachmann J, Hoffmann E, Wojciechowski D, Kornacewicz-Jach Z, Sredniawa B, Lupkovics G, Hofgärtner F, Lubinski A, Rosenqvist M, Habets A, Wegscheider K, Senges J | title = Defibrillator implantation early after myocardial infarction | journal = [[The New England Journal of Medicine]] | volume = 361 | issue = 15 | pages = 1427–36 | year = 2009 | month = October | pmid = 19812399 | doi = 10.1056/NEJMoa0901889 | url = http://dx.doi.org/10.1056/NEJMoa0901889 | issn = | accessdate = 2011-02-04}}</ref> trials did not show a benefit of ICD placement during the first 3 months after STEMI.  Likewise, it should be noted that MADITT II <ref name="pmid11907286">{{cite journal | author = Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML | title = Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction | journal = [[The New England Journal of Medicine]] | volume = 346 | issue = 12 | pages = 877–83 | year = 2002 | month = March | pmid = 11907286 | doi = 10.1056/NEJMoa013474 | url = http://dx.doi.org/10.1056/NEJMoa013474 | issn = | accessdate = 2011-02-04}}</ref> excluded patients who had an MI or revascularization within the preceding 40 days. The results of DINAMIT and IRIS form the basis for the guidelines recommendation that ICD implantation be deferred until 40 days following STEMI.  In DINAMIT, 332 patients were enrolled if they had an MI in the previous 6 to 40 days (the average time of implantation was 18 days following MI) and their LVEF was < 35%. A heart rate > 80 beats per minute or a reduced heart rate variability was required. At 30 days of follow-up, the all cause mortality was 7.5% in ICD patients and 6.9% in placebo patients (p=NS). Non-arrhythmic deaths were more common in the ICD arm, and arrhythmic deaths were more common in the placebo arm.  Similar trends in mortality were observed in the subsequent IRIS trial, which enrolled a larger number of patients (n=898), during a similar period following STEMI (5 to 31 days) with 37 months of follow-up.
|-
| 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]]
|-
|}


===Management of the Patient While Awaiting ICD Placement===
Evidence based treatment with beta-blockers, statins, and ACE-inhibitors should be administered to patients while they await placement of an ICD at 40 days to 3 months following STEMI. An external cardiac defibrillator vest can be prescribed in high risk patients with a low ejection fraction while the patient is awaiting assessment of their LVEF at 3 months.
===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 electrophysiologic testing should not preclude implantation of an ICD.


==ICD Implantation in Patients with Chronic Stable Symptomatic Congestive Heart Failure: The SCD-HeFT Trial==


While the previous trials such as MADITT, MUST, IRIS and DANIMIT focused on post MI patients, the SCD-HeFT trial instead focused on a different population, namely patients with chronic stable symptomatic congestive heart failure (CHF) due to either ischemic or nonischemic cardiomyopathy [25]. In contrast to previous studies where only a reduced ejection fraction was required, in SCD-HeFT symptoms of CHF (NYHA class II or III) were required along with an LVEF of < 35%. For instance, it should be noted that only about two thirds of patients in MADIT II had symptoms of heart failure.  ICD implantation was associated with a reduction in mortality at 5 years versus placebo (29% versus 36%), with similar benefits observed both in patients with ischemic and non-ischemic cardiomyopathy. The third arm, amiodarone therapy, was not associated with a reduction in mortality. Based upon SCD-HeFT, an ICD is indicated in patients with an ischemic cardiomyopathy with NYHA class II – III CHF and an LVEF < 35%.
{{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}}


==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==
===Timing of [[Sudden Cardiac Death]] Following [[ST-elevation MI]] ===
In patients with a large MI with a low EF who are awaiting permanent ICD implantation, use of a wearable defibrillator is a reasonable strategy.
[[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.


==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>==
===Medical Therapy to Prevent Sudden Death Following STEMI===
{{cquote| 
===Class I===


1. [[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)
*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]].


2. [[ICD therapy]] is indicated in patients with structural [[heart disease]] and spontaneous sustained [[VT]], whether hemodynamically stable or unstable. (Level of Evidence: B)
====[[Beta Blockers]]====


3. [[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)
*[[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>.


4. [[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)
====[[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> .


5. [[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)
====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>.


6. [[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)
====[[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>.


7. [[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)
====[[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>.


===Class IIa===
====[[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>.


1. [[ICD implantation]] is reasonable for patients with unexplained [[syncope]], significant [[LV dysfunction]], and [[nonischemic DCM]]. (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>


2. [[ICD implantation]] is reasonable for patients with [[sustained VT]] and normal or near-normal [[ventricular function]]. (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>,


3. [[ICD implantation]] is reasonable for patients with [[HCM]] who have 1 or more major{dagger} risk factors for [[SCD]]. (Level of Evidence: C)
===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]].


4. [[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)
===The Benefit of [[ICD]] Implantation May Be Greater in Patients with a [[QRS]] Duration > 120 msec===


5. [[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)
*In both SCD-HeFT and MADIT II, the reduction in [[SCD]] was greater in patients with a [[QRS]] duration > 120 msec.


6. [[ICD implantation]] is reasonable for non hospitalized patients awaiting [[transplant]]ation. (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.


7. [[ICD implantation]] is reasonable for patients with [[Brugada syndrome]] who have had [[syncope]]. (Level of Evidence: C)
===[[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


8. [[ICD implantation]] is reasonable for patients with [[Brugada syndrome]] who have documented [[VT]] that has not resulted in [[cardiac arrest]]. (Level of Evidence: C)
==See also==


9. [[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)
* [[Sudden cardiac death]]
* [[Sudden cardiac death post arrest care and prevention]]
* [[Post cardiac arrest syndrome care pathway]]
* [[Therapeutic hypothermia]]


10. [[ICD implantation]] is reasonable for patients with [[cardiac sarcoidosis]], [[giant cell myocarditis]], or [[Chagas disease]]. (Level of Evidence: C)
==References==
 
===Class IIb===
 
1. [[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)
 
2. [[ICD therapy]] may be considered for patients with [[long-QT syndrome]] and risk factors for [[SCD]]. (Level of Evidence: B)
 
3. [[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)
 
4. [[ICD therapy]] may be considered in patients with a [[familial cardiomyopathy]] associated with sudden death. (Level of Evidence: C)
 
5. [[ICD therapy]] may be considered in patients with [[LV]] noncompaction. (Level of Evidence: C)
 
===Class III===
 
1. [[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)
 
2. [[ICD therapy]] is not indicated for patients with incessant [[VT]] or [[VF]]. (Level of Evidence: C)


3. [[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)
4. [[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)
5. [[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)
6. [[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)
7. [[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)}}
==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>==
{{cquote| 
===Class I===
1. [[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)
2. [[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)
===Class IIa===
1. [[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)
===Class IIb===
1. [[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)
===Class III===
1. 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) }}
==Unresolved Questions in Identifying the Optimal Patients for ICD Implanatation Following STEMI==
The benefits of ICD placement in those patients over the age of 75 and in those with impaired renal function is not well defined, but post-hoc analyses from randomized trials suggest a lack of benefit in these populations. Non-sustained [[VT]] on Holter monitoring, an abnormal signal averaged EKG, and abnormal micro [[T wave alternans]] are associated with an increased risk of SCD, however, it is not known if ICD therapy is of benefit in these populations.  Normal  0          false  false  false    EN-US  X-NONE  X-NONE                                      MicrosoftInternetExplorer4
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Electrophysiology]]


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Latest revision as of 22:49, 23 July 2023

Sudden cardiac death Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Edzel Lorraine Co, DMD, MD[3]

See also Post cardiac arrest syndrome care pathway

Overview

Prevention

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

Primary Prevention of Sudden Cardiac Death

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

Secondary Prevention of Sudden Cardiac Death

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

Implantable Cardioverter Defibrillator

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

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

Abbreviations: MI: Myocardial infarction; VT: Ventricular tachycardia; VF: Ventricular fibrillation; LVEF: Left ventricular ejection fraction; ICD: Implantable cardioverter defibrillator; NYHA: New York Heart Association functional classification; LVAD: Left ventricular assist device; EPS: Electrophysiology study

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

❑ In patients with LVEF≤ 35% and NYHA class 2,3 heart failure despite medical therapy, at least 40 days post MI or 90 days post revascularization with life expectancy > 1 year
1 year

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

❑ In patients with LVEF ≤ 40% and nonsustained VT due to prior MI or VT ,VF inducible in EPS with life expectancy >1 year

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

❑ In patients with NYHA class 4 who are candidates for cardiac transplantation or LVAD with life expectancy > 1 year

(Class III, Level of Evidence C)

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


 
 
 
 
 
 
Secondary prevention in patients with IHD
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
SCA survivor or sustained monomorph VT
 
 
 
Cardiac syncope
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ischemia
 
 
 
LVEF≤35%
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes: revascularization, reassessment about SCD risk (class1)
 
NO:ICD candidate
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes:ICD (class1)
 
NO: medical therapy (class1)
 
 
Yes:ICD (CLASS1)
 
NO:EP study (class 2a)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ventriculat arrhythmia induction
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes: ICD (class1)
 
NO: monitoring
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Timing of Sudden Cardiac Death Following ST-elevation MI

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

Medical Therapy to Prevent Sudden Death Following STEMI

Beta Blockers

ACE Inhibitor

Angiotensin II Receptor Blockers (ARBs)

Statin Therapy

Aldosterone Antagonists

Anti-arrhythmics

Induced Hypothermia to Improve Neurological Outcome

[13]

Prevention of Sudden Death and Implantable Cardioverter Defibrillators Following STEMI

Role of Electrophysiology Testing

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

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

Wearable Defibrillators

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

Cardiac resynchronization therapy (CRT) Combined with ICD Placement

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

See also

References

  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.
  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).
  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)
  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)
  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)
  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)
  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)
  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)
  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)
  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)
  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)
  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)
  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.
  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.
  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.
  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
  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.
  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)
  19. ↑ 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)

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