Ventricular tachycardia primary prevention
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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.[1]
- In patients with LVEF ≤30% and prior MI and NYHA class I symptoms , ICD implantation was associated with survival benefit.[2]
- 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.[3]
| 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 |
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
| The above table adopted from 2017 AHA/ACC/HRS Guideline |
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| Recommendations for primary prevention of sudden cardiac death in non-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 with survival > 1 year |
| ICD implantation (Class IIa, Level of Evidence B) : |
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❑ In patients with more than 2 risk factors related to cardiomyopathy lamin A/C mutation (LVEF ≤ 45% and nonsustained VT, non missense mutation, male sex), ICD implantation with life expectancy> 1 year |
| ICD implantation : (Class IIb, Level of Evidence B) |
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❑ In patients with NYHA class 1 heart failure and LVEF <35% despite optimal medical therapy, ICD is recommended if 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 or CRT defibrillator |
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;
CRT Cardiac resynchronization therapy
| The above table adopted from 2017 AHA/ACC/HRS Guideline |
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References
- ↑ Hohnloser, Stefan H.; Kuck, Karl Heinz; Dorian, Paul; Roberts, Robin S.; Hampton, John R.; Hatala, Robert; Fain, Eric; Gent, Michael; Connolly, Stuart J. (2004). "Prophylactic Use of an Implantable Cardioverter–Defibrillator after Acute Myocardial Infarction". New England Journal of Medicine. 351 (24): 2481–2488. doi:10.1056/NEJMoa041489. ISSN 0028-4793.
- ↑ Steinbeck, Gerhard; Andresen, Dietrich; Seidl, Karlheinz; Brachmann, Johannes; Hoffmann, Ellen; Wojciechowski, Dariusz; Kornacewicz-Jach, Zdzisława; Sredniawa, Beata; Lupkovics, Géza; Hofgärtner, Franz; Lubinski, Andrzej; Rosenqvist, Mårten; Habets, Alphonsus; Wegscheider, Karl; Senges, Jochen (2009). "Defibrillator Implantation Early after Myocardial Infarction". New England Journal of Medicine. 361 (15): 1427–1436. doi:10.1056/NEJMoa0901889. ISSN 0028-4793.
- ↑ Bristow, Michael R.; Saxon, Leslie A.; Boehmer, John; Krueger, Steven; Kass, David A.; De Marco, Teresa; Carson, Peter; DiCarlo, Lorenzo; DeMets, David; White, Bill G.; DeVries, Dale W.; Feldman, Arthur M. (2004). "Cardiac-Resynchronization Therapy with or without an Implantable Defibrillator in Advanced Chronic Heart Failure". New England Journal of Medicine. 350 (21): 2140–2150. doi:10.1056/NEJMoa032423. ISSN 0028-4793.
- ↑ 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.