Ventricular tachycardia primary prevention
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Differentiating Ventricular Tachycardia from other Disorders |
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Overview
Implantable cardioverter-defibrillator (ICD) can be used for patients with idiopathic dilated cardiomyopathy (DCM) for primary or secondary prevention of ventricular arryhthmias.
Primary Prevention
- Primary prevention strategy for heart failure patients with NYHA class II or III, and LVEF ≤35% at least 40 days after myocardial infarction is ICD implantation.
- In patients with LVEF ≤30% and prior MI and NYHA class I symptoms , ICD implantation was associated with survival benefit.
- Analysis of [MADIT]], MADIT-II, and SCD-HeFT showed survival benefit of ICD implantation for [[primary prevention of ventricular arrhythmia.
- There was not survival benefit of ICD implantation in patients with NYHA class IV heart failure.
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): |
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❑ 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 |
| ICD implantation (Class I, Level of Evidence B) : |
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❑ 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) |
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❑ 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) |
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❑ ICD is not beneficial in patients with NYHA class 4 despite optimal medical therapy who are not candidates for cardiac transplantation or LVAD |