Ventricular tachycardia secondary prevention: Difference between revisions
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==Overview== | ==Overview== | ||
==[[Secondary prevention]]== | ==[[Secondary prevention]]== | ||
Secondary prevention strategies following [[SCA]] and unstable [[VT]] include [[ICD]] implantation, [[ | [[Secondary prevention]] strategies following [[SCA]] and unstable [[VT]] include [[ICD]] implantation, and [[medications]]. | ||
* Based on meta-analysis of [[AVID trial]] implantation of [[ICD]] for [[secondary prevention]] of [[ventricular arrhythmia]] improved survival compared with [[antiarrhythmic]] in [[patients]] who survived of [[sudden cardiac arrest]] or unstable [[VT]]. | * Based on meta-analysis of [[AVID trial]] implantation of [[ICD]] for [[secondary prevention]] of [[ventricular arrhythmia]] improved survival compared with [[antiarrhythmic]] in [[patients]] who survived of [[sudden cardiac arrest]] or unstable [[VT]]. | ||
* Before [[ICD]] implantation, the reversible causes of [[ventricular arrhythmia]] including [[myocardial ischemia]], [[electrolyte disturbance]], [[proarrhythmiac]] medication effect may be corrected. | * Before [[ICD]] implantation, the reversible causes of [[ventricular arrhythmia]] including [[myocardial ischemia]], [[electrolyte disturbance]], [[proarrhythmiac]] medication effect may be corrected. | ||
Revision as of 06:00, 13 May 2021
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Ventricular tachycardia Microchapters |
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Differentiating Ventricular Tachycardia from other Disorders |
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Ventricular tachycardia secondary prevention On the Web |
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Risk calculators and risk factors for Ventricular tachycardia secondary prevention |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in Chief: Avirup Guha, M.B.B.S.[2]
Overview
Secondary prevention
Secondary prevention strategies following SCA and unstable VT include ICD implantation, and medications.
- Based on meta-analysis of AVID trial implantation of ICD for secondary prevention of ventricular arrhythmia improved survival compared with antiarrhythmic in patients who survived of sudden cardiac arrest or unstable VT.
- Before ICD implantation, the reversible causes of ventricular arrhythmia including myocardial ischemia, electrolyte disturbance, proarrhythmiac medication effect may be corrected.
- ICD implantation improved outcome in well-tolerated VT and structurally heart disease.
- VT ablation reduced recurrence, but the effect on long-term mortality was unknown.
- Among patients with ischemia heart disease and syncope due to inducible sustained monomorphic VT, ICD is recommended even if there is not other criteria for primary prevention implantation of ICD.
Abbreviations:
MI: Myocardial infarction;
VT: Ventricular tachycardia;
VF: Ventricular fibrillation;
LVEF: Left ventricular ejection fraction;
ICD: Intracardiac defibrillation;
EPS: Electrophysiology study
| Recommendations for secondary prevention of sudden cardiac death in ischemic heart disease |
| ICD implantation (Class I, Level of Evidence B): |
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❑ In patients with IHD and survivors of SCD due to VT, VF or hermodynamically unstable VT or incessant VT with irreversible cause, ICD should be implanted if survival is more than 1 year. |
| ICD implantation (Intermediate value statement, Level of Evidence B) : |
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❑ In patients with higher risk of death due to ventricular arrhythmia and lower risk of non cardiac death due to other comorbidities, ICD implantation has intermediate value. |
| ICD implantation : (Class I, Level of Evidence B) |
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❑ In patients with IHD and unexplained syncope with induction of sustained monomorphic VT in EPS, ICD implantation is recommended if life expectancy is more than 1 year |
| 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 | ||||||||||||||||||||||||||||||||||||||||||||