== 2006 ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT) <ref name="pmid16935995">{{cite journal| author=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al.| title=ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=Circulation | year= 2006 | volume= 114 | issue= 10 | pages= e385-484 | pmid=16935995 | doi=10.1161/CIRCULATIONAHA.106.178233 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16935995}}</ref> ==
== 2006 ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT) <ref name="pmid16935995">{{cite journal| author=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al.| title=ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=Circulation | year= 2006 | volume= 114 | issue= 10 | pages= e385-484 | pmid=16935995 | doi=10.1161/CIRCULATIONAHA.106.178233 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16935995}}</ref> ==
===Ablation (DO NOT EDIT) <ref name="pmid16935995">{{cite journal| author=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al.| title=ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=Circulation | year= 2006 | volume= 114 | issue= 10 | pages= e385-484 | pmid=16935995 | doi=10.1161/CIRCULATIONAHA.106.178233 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16935995}}</ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"| <nowiki>"</nowiki>'''1.''' [[Catheter ablation|Ablation]] is indicated in patients who are otherwise at low risk for [[Sudden Cardiac Death|SCD]] and have sustained predominantly [[monomorphic ventricular tachycardia|monomorphic VT]] that is drug resistant, who are drug intolerant, or who do not wish long-term drug therapy. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen"| <nowiki>"</nowiki>'''2.''' [[Catheter ablation|Ablation]] is indicated in patients with [[Bundle branch reentrant ventricular tachycardia|bundle branch reentrant VT]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen"| <nowiki>"</nowiki>'''3.''' [[Catheter ablation|Ablation]] is indicated as adjunctive therapy in patients with an [[ICD]] who are receiving multiple shocks as a result of [[Sustained VT|sustained VT]] that is not manageable by reprogramming or changing drug therapy or who do not wish long-term drug therapy. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<ref name="pmid2856866">{{cite journal| author=Bhandari AK, Shapiro WA, Morady F, Shen EN, Mason J, Scheinman MM| title=Electrophysiologic testing in patients with the long QT syndrome. | journal=Circulation | year= 1985 | volume= 71 | issue= 1 | pages= 63-71 | pmid=2856866 | doi= | pmc= | url= }} </ref><ref name="pmid15271018">{{cite journal| author=Silva RM, Mont L, Nava S, Rojel U, Matas M, Brugada J| title=Radiofrequency catheter ablation for arrhythmic storm in patients with an implantable cardioverter defibrillator. | journal=Pacing Clin Electrophysiol | year= 2004 | volume= 27 | issue= 7 | pages= 971-5 | pmid=15271018 | doi=10.1111/j.1540-8159.2004.00567.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15271018 }} </ref> <nowiki>"</nowiki>
|-
| bgcolor="LightGreen"| <nowiki>"</nowiki>'''4.''' [[Catheter ablation|Ablation]] is indicated in patients with [[WPW syndrome|Wolff-Parkinson-White syndrome]] resuscitated from [[sudden cardiac arrest]] due to [[atrial fibrillation]] and rapid conduction over the accessory pathway causing [[VF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<ref name="pmid14602878">{{cite journal| author=Pappone C, Santinelli V, Manguso F, Augello G, Santinelli O, Vicedomini G et al.| title=A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome. | journal=N Engl J Med | year= 2003 | volume= 349 | issue= 19 | pages= 1803-11 | pmid=14602878 | doi=10.1056/NEJMoa035345 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14602878</ref> <nowiki>"</nowiki>
|}
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
|bgcolor="LightCoral"| <nowiki>"</nowiki>'''1.''' [[Catheter ablation|Ablation]] of asymptomatic relatively infrequent [[PVCs]] is not indicated. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Ablation can be useful therapy in patients who are otherwise at low risk for [[SCD]] and have symptomatic [[nonsustained monomorphic VT]] that is drug resistant, who are drug intolerant or who do not wish long-term drug therapy.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki> '''2.''' Ablation can be useful therapy in patients who are otherwise at low risk for [[SCD]] and have frequent symptomatic predominantly [[monomorphic PVCs]] that are drug resistant or who are drug intolerant or who do not wish long-term drug therapy.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki> '''3.''' [[Catheter ablation|Ablation]] can be useful in symptomatic patients with [[WPW syndrome|Wolff-Parkinson-White syndrome]] who have [[accessory pathways]] with refractory periods less than 240 ms in duration. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<ref name="pmid14602878">{{cite journal| author=Pappone C, Santinelli V, Manguso F, Augello G, Santinelli O, Vicedomini G et al.| title=A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome. | journal=N Engl J Med | year= 2003 | volume= 349 | issue= 19 | pages= 1803-11 | pmid=14602878 | doi=10.1056/NEJMoa035345 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14602878 }} </ref><nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"| <nowiki></nowiki> '''1.''' "Ablation of [[Purkinje fiber]] potentials may be considered in patients with [[ventricular arrhythmia]] storm consistently provoked by [[PVCs]] of similar morphology. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<ref name="pmid12186801">{{cite journal| author=Haïssaguerre M, Shoda M, Jaïs P, Nogami A, Shah DC, Kautzner J et al.| title=Mapping and ablation of idiopathic ventricular fibrillation. | journal=Circulation | year= 2002 | volume= 106 | issue= 8 | pages= 962-7 | pmid=12186801 | doi= | pmc= | url= }} </ref><nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"| <nowiki></nowiki> '''2.''' "[[Catheter ablation|Ablation]] of asymptomatic [[PVCs]] may be considered when the PVCs are very frequent to avoid or treat [[cardiomyopathy|tachycardia-induced cardiomyopathy]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<ref name="pmid15837259">{{cite journal| author=Takemoto M, Yoshimura H, Ohba Y, Matsumoto Y, Yamamoto U, Mohri M et al.| title=Radiofrequency catheter ablation of premature ventricular complexes from right ventricular outflow tract improves left ventricular dilation and clinical status in patients without structural heart disease. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 8 | pages= 1259-65 | pmid=15837259 | doi=10.1016/j.jacc.2004.12.073 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15837259 }} </ref><nowiki>"</nowiki>
|}
===Management of Cardiac Arrest (DO NOT EDIT) <ref name="pmid16935995">{{cite journal| author=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al.| title=ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=Circulation | year= 2006 | volume= 114 | issue= 10 | pages= e385-484 | pmid=16935995 | doi=10.1161/CIRCULATIONAHA.106.178233 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16935995}}</ref> ===
===Management of Cardiac Arrest (DO NOT EDIT) <ref name="pmid16935995">{{cite journal| author=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al.| title=ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=Circulation | year= 2006 | volume= 114 | issue= 10 | pages= e385-484 | pmid=16935995 | doi=10.1161/CIRCULATIONAHA.106.178233 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16935995}}</ref> ===
Long term anti-arrhythmic therapy may be indicated to prevent recurrence of VT. Beta-blockers and a number of class III anti-arrhythmics are commonly used.
For some of the rare congenital syndromes of VT, other drugs, and sometimes even catheter ablation therapy may be useful.
The implantation of an ICD is more effective than drug therapy for prevention of sudden cardiac death due to VT and VF, but may be constrained by cost issues, and well as patient comorbidities and patient preference.
2006 ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT) [1]
"1. After establishing the presence of definite, suspected, or impending cardiac arrest, the first priority should be activation of a response team capable of identifying the specific mechanism and carrying out prompt intervention. (Level of Evidence: B) "
"3. In an out-of-hospital setting, if an AED is available, it should be applied immediately and shock therapy administered according to the algorithms contained in the documents on CPR[2][3] developed by the AHA in association with the International Liaison Committee on Resuscitation (ILCOR) and/or the European Resuscitation Council (ERC). (Level of Evidence: C) "
"4. For victims with ventricular tachyarrhythmic mechanisms of cardiac arrest, when recurrences occur after a maximally defibrillating shock (generally 360 J for monophasic defibrillators), intravenous amiodarone should be the preferred antiarrhythmic drug for attempting a stable rhythm after further defibrillations. (Level of Evidence: B) "
" 1. For response times greater than or equal to 5 min, a brief (less than 90 to 180 s) period of CPR is reasonable prior to attempting defibrillation. (Level of Evidence: B ) "
"1. Patients presenting with sustained VT in whom low level elevations in cardiac biomarkers of myocyte injury/necrosis are documented should be treated similarly to patients who have sustained VT and in whom no biomarker rise is documented. (Level of Evidence: C)"
Sustained Monomorphic Ventricular Tachycardia (DO NOT EDIT) [1]
" 2. Intravenous amiodarone is reasonable in patients with sustained monomorphic VT that is hemodynamically unstable, refractory to conversion with countershock, or recurrent despite procainamide or other agents. (Level of Evidence: C) "
"2. Intravenous beta blockers are useful for patients with recurrent polymorphic VT, especially if ischemia is suspected or cannot be excluded. (Level of Evidence: B) "
"3. Intravenous loading with amiodarone is useful for patients with recurrent polymorphic VT in the absence of abnormal repolarization related to congenital or acquired LQTS. (Level of Evidence: C) "
" 1. Intravenous lidocaine may be reasonable for treatment of polymorphic VT specifically associated with acute myocardial ischemia or infarction. (Level of Evidence: C)"
"4.Isoproterenol is reasonable as temporary treatment in acute patients who present with recurrent pause-dependent torsades de pointes who do not have congenital LQTS. (Level of Evidence: B)"
"1.Catheter ablation is useful in patients with structurally normal hearts with symptomatic, drug-refractory VT arising from the RV or LV or in those who are drug intolerant or who do not desire long-term drug therapy. (Level of Evidence: C)"
"1. High intermittent doses and cumulative doses exceeding the recommended levels should be avoided in patients receiving anthracyclines such as doxorubicin. (Level of Evidence: B)"
"2. All patients receiving 5-fluorouracil therapy should receive close supervision and immediate discontinuation of the infusion if symptoms or signs of myocardial ischemia occur. Further treatment with 5-fluorouracil must be avoided in these individuals. (Level of Evidence: C)"