Ventricular tachycardia future or investigational therapies: Difference between revisions
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== Future or investigational studies == | == Future or investigational studies == | ||
In recent years, the results of [[pharmacologic]] [[therapy]] for preventing VAs are disappointing. Therapy limitations are due to variable [[efficacy]], pro-arrhythmic effects, [[patient]] [[compliance]], and [[adverse effects]] from long-term [[therapy]]. in [[patients]] with [[ICD|ICDs]], [[adjuvant]] suppressive [[therapy]] as [[amiodarone]] and [[sotalol]] have been shown to reduce the rate of recurrent VT when compared with [[beta-blockers]] or [[placebo]]. [[Pharmacologic]] [[therapy]] ([[amiodarone]] or [[sotalol]]) with or without [[adjunctive]] [[catheter ablation]] are recommended by the current guidelines to prevent VT/VF recurrence and reducing [[ICD]] shocks<ref name="pmid28721212">{{cite journal| author=Batul SA, Olshansky B, Fisher JD, Gopinathannair R| title=Recent advances in the management of ventricular tachyarrhythmias. | journal=F1000Res | year= 2017 | volume= 6 | issue= | pages= 1027 | pmid=28721212 | doi=10.12688/f1000research.11202.1 | pmc=5497814 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28721212 }}</ref> | In recent years, the results of [[pharmacologic]] [[therapy]] for preventing VAs are disappointing. Therapy limitations are due to variable [[efficacy]], pro-arrhythmic effects, [[patient]] [[compliance]], and [[adverse effects]] from long-term [[therapy]]. in [[patients]] with [[ICD|ICDs]], [[adjuvant]] suppressive [[therapy]] as [[amiodarone]] and [[sotalol]] have been shown to reduce the rate of recurrent VT when compared with [[beta-blockers]] or [[placebo]]. [[Pharmacologic]] [[therapy]] ([[amiodarone]] or [[sotalol]]) with or without [[adjunctive]] [[catheter ablation]] are recommended by the current guidelines to prevent VT/VF recurrence and reducing [[ICD]] shocks<ref name="pmid28721212">{{cite journal| author=Batul SA, Olshansky B, Fisher JD, Gopinathannair R| title=Recent advances in the management of ventricular tachyarrhythmias. | journal=F1000Res | year= 2017 | volume= 6 | issue= | pages= 1027 | pmid=28721212 | doi=10.12688/f1000research.11202.1 | pmc=5497814 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28721212 }}</ref> | ||
The goals of management of VAs include: | The goals of management of VAs include: | ||
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* Preventing deterioration of left ventricular function | * Preventing deterioration of left ventricular function | ||
* Reducing risk of arrhythmic death | * Reducing risk of arrhythmic death | ||
* Improving overall survival7–10. Treatment of underlying medical conditions, the cardiac disorders, the presence of heart failure, the cause for the arrhythmias, consequences of the VAs, and the risks and benefits of the therapeutic pharmacological or invasive strategy<ref name="pmid26320108">{{cite journal| author=Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J | display-authors=etal| title=2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). | journal=Eur Heart J | year= 2015 | volume= 36 | issue= 41 | pages= 2793-2867 | pmid=26320108 | doi=10.1093/eurheartj/ehv316 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26320108 }}</ref><br /> | * Improving overall survival7–10. Treatment of underlying medical conditions, the cardiac disorders, the presence of heart failure, the cause for the arrhythmias, consequences of the VAs, and the risks and benefits of the therapeutic pharmacological or invasive strategy<ref name="pmid26320108">{{cite journal| author=Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J | display-authors=etal| title=2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). | journal=Eur Heart J | year= 2015 | volume= 36 | issue= 41 | pages= 2793-2867 | pmid=26320108 | doi=10.1093/eurheartj/ehv316 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26320108 }}</ref> | ||
*Recent research and clinical advances allowed to tailor the approach to to VA management on the basis of the underlying etiology with higher efficacy. These advances have been focused on the development of diagnostic modalities and imaging tools to identify the arrhythmogenic substrate responsible for VT (focal or scar), genetic screening for markers of channelopathies, and superior mapping and ablation technologies. <br /> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 16:29, 10 March 2020
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Overview
In recent years, the results of pharmacologic therapy for preventing VAs are disappointing. Therapy limitations are due to variable efficacy, pro-arrhythmic effects, patient compliance, and adverse effects from long-term therapy. in patients with ICDs, adjuvant suppressive therapy as amiodarone and sotalol have been shown to reduce the rate of recurrent VT when compared with beta-blockers or placebo. Pharmacologic therapy (amiodarone or sotalol) with or without adjunctive catheter ablation are recommended by the current guidelines to prevent VT/VF recurrence and reducing ICD shocks
Future or investigational studies
In recent years, the results of pharmacologic therapy for preventing VAs are disappointing. Therapy limitations are due to variable efficacy, pro-arrhythmic effects, patient compliance, and adverse effects from long-term therapy. in patients with ICDs, adjuvant suppressive therapy as amiodarone and sotalol have been shown to reduce the rate of recurrent VT when compared with beta-blockers or placebo. Pharmacologic therapy (amiodarone or sotalol) with or without adjunctive catheter ablation are recommended by the current guidelines to prevent VT/VF recurrence and reducing ICD shocks[1]
The goals of management of VAs include:
- Symptom relief (including syncope, worsening heart failure, and ischemic chest pain),
- Improving quality of life, * Reducing implantable cardioverter defibrillator (ICD) shocks,
- Preventing deterioration of left ventricular function
- Reducing risk of arrhythmic death
- Improving overall survival7–10. Treatment of underlying medical conditions, the cardiac disorders, the presence of heart failure, the cause for the arrhythmias, consequences of the VAs, and the risks and benefits of the therapeutic pharmacological or invasive strategy[2]
- Recent research and clinical advances allowed to tailor the approach to to VA management on the basis of the underlying etiology with higher efficacy. These advances have been focused on the development of diagnostic modalities and imaging tools to identify the arrhythmogenic substrate responsible for VT (focal or scar), genetic screening for markers of channelopathies, and superior mapping and ablation technologies.
References
- ↑ Batul SA, Olshansky B, Fisher JD, Gopinathannair R (2017). "Recent advances in the management of ventricular tachyarrhythmias". F1000Res. 6: 1027. doi:10.12688/f1000research.11202.1. PMC 5497814. PMID 28721212.
- ↑ Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J; et al. (2015). "2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC)". Eur Heart J. 36 (41): 2793–2867. doi:10.1093/eurheartj/ehv316. PMID 26320108.