Materiały źródłowe

• #1 Ventricular tachycardia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ventricular-tachycardia/diagnosis-treatment/drc-20355144

  Ventricular tachycardia that lasts longer than 30 seconds, called sustained V-tach, needs emergency medical treatment. Sustained V-tach may sometimes lead to sudden cardiac death. […] The goals of ventricular tachycardia treatment are to: Slow a rapid heartbeat. Prevent future episodes of a fast heartbeat. […] Ventricular tachycardia treatment may include medicines, procedures and devices to control or reset the heart rhythm, and heart surgery. […] If another medical condition is causing tachycardia, treating the underlying problem may reduce or prevent episodes of a fast heartbeat. […] A surgery or procedure may be needed to control or prevent episodes of tachycardia. […] Some people with tachycardia need a device to help control the heartbeat and reset the heart rhythm.

• #2 Treatment and prophylaxis of ventricular arrhythmias in acute myocardial infarction – PubMed

  https://pubmed.ncbi.nlm.nih.gov/6624651/

  Remarkable advances have been made in the management of cardiac disease in the last 20 years, but antiarrhythmic drug strategy in the acute phase of myocardial infarction remains less than satisfactory. […] Management must be either expectant or prophylactic. […] yet safe and effective prevention of VF is an attractive therapeutic goal. […] Adoption of a prophylactic regimen mandates drug administration to a large number of patients who either are not at risk of developing VF (noninfarct patients) or who are destined not to develop VF (70 to 95% of infarct patients). […] Reevaluation of antiarrhythmic drug use and arrhythmia treatment in acute myocardial infarction is long overdue. […] However, there is a paucity of controlled data upon which to base new strategies, and clinical research in this field is hampered by ethical considerations, by rigidly held but unscientifically based beliefs and by a lack of fundamental knowledge of arrhythmia mechanisms and their significance.

• #3

  https://www.cardiosmart.org/news/2017/10/guideline-for-ventricular-arrhythmias-and-prevention-of-sudden-cardiac-death

  This guideline applies to patients with ventricular arrhythmias, which are abnormal heart rhythms that occur in the lower chambers of the heart (ventricles). […] The recent guidelines highlight the importance of screening patients with heart rhythm problems for risk of sudden cardiac death. Some patients are at very high-risk, and its important they take steps to lower that risk. […] Steps to reduce risk for sudden cardiac death can include: Keeping key risk factors for heart disease in check such as high blood pressure, high cholesterol, obesity and diabetes. […] Taking medication. […] Undergoing procedures. For example, an implantable cardioverter defibrillator is a device that can be placed in the chest to monitor the heart and correct dangerous rhythms. A procedure called ablation can prevent abnormal heart rhythms by destroying the heart tissue that causes them. However, treatment depends on the type of arrhythmia and each patient. […] Shared decision making with patients and their health care professionals is important. Treatment options depend on what patients health goals are, what they prefer and value, as well as the best available scientific evidence.

• #4 Ventricular Tachycardia in Texas | The Heart Institute of East Texas

  https://www.hiet.com/ventricular-tachycardia/

  The best way to prevent ventricular tachycardia is to treat or eliminate risk factors that may lead to heart disease. If you already have heart disease, follow your treatment plan and a heart-healthy lifestyle. […] Take the following steps: […] Exercise and eat a healthy diet. Live a heart-healthy lifestyle by exercising regularly and eating a healthy, low-fat diet that’s rich in fruits, vegetables and whole grains. […] Maintain a healthy weight. Being overweight increases your risk of developing heart disease. […] Keep blood pressure and cholesterol levels under control. Make lifestyle changes and take medications as prescribed to correct high blood pressure (hypertension) or high cholesterol. […] Control stress. Avoid unnecessary stress and learn coping techniques to handle normal stress in a healthy way.

• #5 Ventricular Fibrillation: Symptoms, Causes, and Treatment

  https://www.healthline.com/health/ventricular-fibrillation

  A healthy lifestyle and healthcare are vital to keeping your heart healthy and lowering your risk of VF. This means: […] You should eat a heart-healthy diet. […] You should stay active, such as by walking 30 minutes per day. […] If you smoke, start thinking about ways to help you quit. Smoking can affect your arteries flexibility and overall cell health. Taking steps to quit can make a dramatic difference in your heart health. […] Avoid drinking excess alcohol, which can put extra stress on your heart. […] Maintaining a healthy weight, blood pressure, and cholesterol levels can also help to prevent cardiac issues, such as VF. […] If you have a chronic health condition such as diabetes, thyroid condition or kidney disease, take treatment as prescribed by your doctor and go to your regular check-ups.

• #6 Ventricular Tachycardia in Texas | The Heart Institute of East Texas

  https://www.hiet.com/ventricular-tachycardia/

  Don’t use recreational drugs. Don’t use stimulants, such as cocaine. Talk to your doctor about an appropriate program for you if you need help ending recreational drug use. […] Go to scheduled checkups. Have regular physical exams and report any signs or symptoms to your doctor. […] Limit alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger. For some conditions it’s recommended that you completely avoid alcohol. Ask your doctor for advice specific to your condition. […] Limit caffeine. If you drink caffeinated beverages, do so in moderation (no more than one to two beverages daily). […] Stop smoking. If you smoke and can’t quit on your own, talk to your doctor about strategies or programs to help you break a smoking habit. […] Use over-the-counter medications with caution. Some cold and cough medications contain stimulants that may trigger a rapid heartbeat. Ask your doctor which medications you need to avoid.

• #7 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content?ContentTypeID=134&ContentID=231

  Prevention focuses on treating the heart problems that cause VT. This may include: […] For some people, caffeine or alcohol can trigger VT episodes. Don’t use them if they affect your VT.

• #8 Ventricular Tachycardia: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/heart-disease/atrial-fibrillation/what-is-ventricular-tachycardia

  You may not be able to completely prevent ventricular tachycardia, but there are steps you can take to lessen your chances of it happening. You’ll want to focus on heart-healthy habits including: […] Be careful with stimulants like caffeine. […] And make sure you talk to your doctor about: […] There may be other ways to lessen your chances of triggering an irregular heart rhythm. Ask your medical team for more tips.

• #9 Ventricular Tachycardia: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/ventricular-tachycardia

  If you have structural heart disease or another risk factor for ventricular tachycardia, there may be ways to lower your risk for developing this heart rhythm through medication or an implantable device to regulate your heartbeat. […] Other prevention methods may include: avoiding certain drugs that prolong your QT interval the time it takes for your heart to contract and recover, keeping your potassium and magnesium levels in a normal range, keeping thyroid and kidney function in the normal range.

• #10 Ventricular Tachycardia | Kettering Health

  https://ketteringhealth.org/conditions/ventricular-tachycardia/

  VT prevention focuses on treating the underlying heart problems that cause the disorder. This may include: […] Taking medicines for heart failure […] Treating heart artery disease […] Having surgery to fix heart valve problems […] Following a heart-healthy diet and exercise plan, to help reduce your risk for some of these conditions […] For some people, caffeine or alcohol can be a trigger for VT episodes. Avoid these things if they affect your VT.

• #11 2017 Guideline for Management of Ventricular Arrhythmias and Prevention of SCD

  https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/10/29/08/56/2017-guideline-for-management-of-patients-with-ventricular-arrhythmias

  The following are summary points from the American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Rhythm Society (HRS) Guideline for Management of Patients With Ventricular Arrhythmias (VAs) and the Prevention of Sudden Cardiac Death (SCD): […] In patients with heart failure (HF) with reduced ejection fraction (left ventricular ejection fraction [LVEF] 40%), treatment with a beta-blocker, a mineralocorticoid receptor antagonist, and either an angiotensin-converting enzyme inhibitor or an angiotensin-receptor blocker, or an angiotensin receptor-neprilysin inhibitor is recommended to reduce SCD and all-cause mortality (Class I). […] In patients with ischemic heart disease and sustained monomorphic ventricular tachycardia (VT), coronary revascularization alone is not effective therapy to prevent recurrent VT (Class III).

• #12 Antiarrhythmic drugs in acute ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation) – The Cardiovascular

  https://ecgwaves.com/docs/antiarrhythmic-drugs-in-acute-ventricular-arrhythmias-ventricular-tachycardia-ventricular-fibrillation/

  Among the antiarrhythmic agents, only beta-blockers have been demonstrated to provide long-term protection for sudden cardiac arrest (SCA) and sudden cardiac death (SCD). Other antiarrhythmic drugs have failed to show efficacy in the prevention of SCD in randomized controlled trials. ICDs are effective for long-term prevention of SCD. Beta-blockers are also effective in treating acute ventricular tachycardia, irrespective of type. […] Administration of prophylactic lidocaine upon return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) is associated with less recurrent VF/VT arrest. Thus, lidocaine may be used as prophylaxis after OHCA. Whether the same holds true for amiodarone remains unknown. […] If antiarrhythmic agents fail to treat monomorphic VT, catheter ablation should be considered as an effective alternative.

• #13 ACC/AHA/HRS Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death Guideline Summary

  https://www.guidelinecentral.com/guideline/6995/

  In patients with heart failure with reduced ejection fraction (HFrEF) (LVEF 40%), treatment with a beta blocker, a mineralocorticoid receptor antagonist and either an angiotensin-converting enzyme inhibitor, an angiotensin-receptor blocker, or an angiotensin receptor-neprilysin inhibitor is recommended to reduce SCD and all-cause mortality. (I, A) 573

• #14 Management of Arrhythmias, Part II: Ventricular Arrhythmias

  https://www.uspharmacist.com/article/management-of-arrhythmias-part-ii-ventricular-arrhythmias

  Ventricular arrhythmias are disturbances in cardiac impulse generation or conduction that occur below the level of the bundle of His, which separates the atrial and ventricular tissues. […] Treatment for PVCs is based on the presence of structural heart disease and symptoms. In patients with no evidence of heart disease, PVCs are generally not associated with an increased risk of mortality. […] The frequency of these palpitations may be diminished by reducing or eliminating smoking, excessive caffeine consumption, alcohol intake, and use of drugs such as amphetamines. […] If otherwise healthy patients present with multiple PVCs and have severe symptoms, beta-blockers are the treatment of choice. […] Patients without structural heart disease do not require treatment unless they are symptomatic. Beta-blockers are the preferred therapy in this instance.

• #15 Amiodarone in ventricular arrhythmias: still a valuable resource?

  https://www.imrpress.com/journal/RCM/22/4/10.31083/j.rcm2204143/htm

  Amiodarone is a Class III Vaughan-Williams anti-arrhythmic drug widely used in ventricular arrhythmias for its efficacy and low pro-arrhythmogenic effect. […] Moreover, all the latest evidence on its role in different clinical settings is provided, including the prevention of sudden cardiac death, implanted cardioverter defibrillators, ischemic and non-ischemic cardiomyopathies. […] Amiodarone should be considered in patients that are symptomatic due to PVCs or NSVTs, or if PVCs or NSVTs contribute to reduced LVEF. […] Amiodarone should be considered to prevent VT in patients with or without an ICD. […] Amiodarone or catheter ablation is recommended in patients with recurrent ICD shocks due to sustained VT. […] Amiodarone or catheter ablation should be considered after a first episode of sustained VT in patients with an ICD.

• #16 Amiodarone in ventricular arrhythmias: still a valuable resource?

  https://www.imrpress.com/journal/RCM/22/4/10.31083/j.rcm2204143/htm

  The efficacy of amiodarone in HFrEF has been controversial. […] However, subsequent trials did not confirm these findings. […] Amiodarone should be considered in patients with an ICD that experience recurrent appropriate shocks despite optimal device programming. […] Amiodarone therapy is often used concomitantly with an ICD implantation to reduce VA burden and appropriate and inappropriate ICD shocks. […] The randomized CASCADE study was conducted in secondary prevention of survivors of out of hospital cardiac arrests (OHCA) due to VF and thought to be at high risk of recurrence because of CAD or heart failure. Amiodarone, compared to class I AAD, reduced endpoints of cardiac death, cardiac arrest from ventricular fibrillation with resuscitation, and rates of ICD shock. […] Amiodarone use in cardiac arrest during a resuscitation protocol has been assessed by the ARREST and ALIVE trials.

• #17 Amiodarone in ventricular arrhythmias: still a valuable resource?

  https://www.imrpress.com/journal/RCM/22/4/10.31083/j.rcm2204143/htm

  In both trials amiodarone demonstrated increased rates of survival at admission to the hospital. […] Amiodarone was effective in suppressing VT where other class I AADs had failed. […] In patients with recent MI, with contraindications to beta-blockers, amiodarone reduced VAs, overall mortality, cardiac mortality, and SCD. […] Amiodarone is considered a second line drug in patients who are intolerant or have contraindications to beta-blockers. […] Amiodarone may be considered when an ICD is not feasible or not preferred by the patient to prevent the incidence of NSVT, which is associated with a substantial increase in sudden death risk in young patients with hypertrophic cardiomyopathy. […] Amiodarone is a powerful tool in the treatment of VAs, but its common and often severe side effects prompt judicious use based on guidelines and clinical practice.

• #18

  https://journals.lww.com/americantherapeutics/Fulltext/2019/08000/Prevention_of_Recurrent_Ventricular_Tachycardia_in.5.aspx?generateEpub=Article%7Camericantherapeutics:2019:08000:00005%7C10.1097/mjt.0000000000000928%7C

  The optimal management for the prevention of recurrent ventricular tachycardia in patients with implantable cardioverter-defibrillators (ICDs) offers a challenge with no set guidelines regarding which therapy offers a best safety and efficacy profile. […] The most effective treatment for the prevention of recurrent ventricular tachycardia after ICD is amiodarone followed by CA. Amiodarone is most effective in the reduction of appropriate and inappropriate ICD shocks with an odds ratio (OR) of 0.29 [95% confidence interval (CI), 0.110.74] and 0.15 (95% CI, 0.040.60), respectively. […] Amiodarone remains the most efficacious therapy for the reduction of appropriate and inappropriate shocks in patients with ICD. No therapy resulted in mortality reduction, but amiodarone showed a trend toward increased mortality.

• #19 Ventricular tachycardia – Wikipedia

  https://en.wikipedia.org/wiki/Ventricular_tachycardia

  Ventricular tachycardia can occur due to coronary heart disease, aortic stenosis, cardiomyopathy, electrolyte imbalance, or a heart attack. […] An implantable cardiac defibrillator or medications such as calcium channel blockers or amiodarone may be used to prevent recurrence. […] 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, such as the beta-blockers carvedilol, metoprolol, and bisoprolol, and the Potassium-Channel-Blockers amiodarone, dronedarone, bretylium, sotalol, ibutilide, and dofetilide. […] An ICD (implantable cardioverter defibrillator) is more effective than drug therapy for prevention of sudden cardiac death due to VT and VF, but does not prevent these rhythms from happening. […] Catheter ablation is a potentially definitive treatment option for those with recurrent VT.

• #20 2022 ESC Guidelines for Ventricular Arrhythmias: Key Points

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/09/02/14/23/2022-ESC-Guidelines-for-VAs-ESC-2022

  In patients with PVCs/VT and a presentation not typical for an idiopathic origin, cardiac magnetic resonance (CMR) should be considered, despite a normal echocardiogram. […] Catheter ablation or flecainide should be considered in symptomatic patients with idiopathic VT/PVCs from an origin other than the RVOT or the left fascicles. […] In patients with an unexplained reduced EF and a PVC burden of 10%, PVC-induced cardiomyopathy should be considered. […] In patients with suspected PVC-induced cardiomyopathy, CMR should be considered. […] In patients with a cardiomyopathy suspected to be caused by frequent and predominantly monomorphic PVCs, catheter ablation is recommended. […] In nonresponders to cardiac resynchronization therapy with frequent, predominantly monomorphic PVCs limiting optimal biventricular pacing despite pharmacological therapy, catheter ablation or antiarrhythmic drugs should be considered.

• #21 The Role of Ranolazine in the Treatment of Ventricular Tachycardia and Atrial Fibrillation: A Narrative Review of the Clinical Evidence

  https://www.mdpi.com/2227-9059/12/8/1669

  Ranolazine reduces VT incidence, although this effect is not universal. […] Ranolazine was found to significantly reduce the incidence of VT and ventricular fibrillation (VF) episodes requiring anti-tachycardia pacing (ATP) or ICD shock, when compared to placebo. […] The benefits of ranolazine were limited to the following subgroups: (1) patients receiving ranolazine monotherapy (without any concomitant antiarrhythmics); (2) those who have cardiac resynchronization therapy–defibrillator (CRT-D) in place; and (3) patients without atrial fibrillation. […] Our thorough data review suggests that, when used specifically for the management or prevention of VT, certain populations may experience a greater benefit from ranolazine therapy. […] Ranolazine may elicit an antiarrhythmic effect similar to that of other agents, and its additional benefit may no further be detectable.

• #22 The Role of Ranolazine in the Treatment of Ventricular Tachycardia and Atrial Fibrillation: A Narrative Review of the Clinical Evidence

  https://www.mdpi.com/2227-9059/12/8/1669

  Ranolazine was significantly more effective in patients with an implanted CRT-D device compared to those with an ICD. […] Importantly, based on a limited number of animal experiments, ranolazine does not appear to alter the defibrillation threshold and, therefore, it does not reduce the safety margin for successful defibrillation. […] Based on available clinical trial data, ranolazine appears to be an effective and safe agent reducing the incidence of VT.

• #23 Ventricular arrhythmias during acute myocardial infarction: Prevention and treatment – UpToDate

  https://www.uptodate.com/contents/ventricular-arrhythmias-during-acute-myocardial-infarction-prevention-and-treatment/print

  Ventricular arrhythmias during acute myocardial infarction: Prevention and treatment […] This topic will focus on the prevention and treatment of ventricular arrhythmias during and immediately after acute MI. […] Frequent premature ventricular complexes (PVCs), VT, and ventricular fibrillation (VF) are all associated with increased long-term mortality following acute MI. […] The following is a summary of the multi-modality approach to prevention of ventricular arrhythmias following MI (STEMI), which includes treatment of ischemia, electrolyte supplementation (if needed), and beta blockers. […] Patients with ventricular arrhythmias, especially polymorphic VT or VF, in the setting of an acute MI should receive aggressive treatment for both the arrhythmia and myocardial ischemia. […] In the post-MI setting, we maintain levels of serum potassium ≥4 mEq/L and serum magnesium ≥2 mg/dL.

• #24 Antiarrhythmic drugs in acute ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation) – The Cardiovascular

  https://ecgwaves.com/docs/antiarrhythmic-drugs-in-acute-ventricular-arrhythmias-ventricular-tachycardia-ventricular-fibrillation/

  The risk of degeneration to ventricular fibrillation (VF) is substantially higher in polymorphic VT, as compared with monomorphic VT. Ongoing myocardial ischemia is the most common cause of polymorphic VT. […] Always search for and correct reversible causes of ventricular arrhythmias. These should be treated simultaneously with the administration of antiarrhythmic agents. Acute decompensated heart failure, acute myocardial ischemia, electrolyte disturbances (hypokalemia, hypomagnesemia), etc, are such causes. […] In the context of antiarrhythmic drugs, structural heart disease (SHD) is defined as ischemic heart disease, valvular heart disease, congenital heart disease, ventricular hypertrophy or myocardial disease. Structural heart disease confers a substantial risk of ventricular arrhythmias and a significant risk of proarrhythmic effects of antiarrhythmic drugs. While several antiarrhythmic drug classes are available for emergency treatment of VT/VF in these patients, long-term treatment is limited mostly to amiodarone, beta-blockers or sotalol. In patients with structural heart disease, only amiodarone and beta-blockers are considered safe (with regards to proarrhythmic effects) for long-term use without the implantation of an ICD.

• #25 2017 Guideline for Management of Ventricular Arrhythmias and Prevention of SCD

  https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/10/29/08/56/2017-guideline-for-management-of-patients-with-ventricular-arrhythmias

  In patients with nonischemic cardiomyopathy, HF with New York Heart Association class IIIII symptoms and an LVEF of 35%, despite guideline-directed management and therapy, an implantable cardioverter-defibrillator (ICD) is recommended if meaningful survival of 1 year is expected. […] In patients with prior myocardial infarction and recurrent episodes of symptomatic sustained ventricular tachycardia (VT), or who present with VT or ventricular fibrillation storm and have failed or are intolerant of amiodarone (Level of Evidence B-R) or other antiarrhythmic medications (Level of Evidence B-NR), catheter ablation is recommended. […] For patients who require arrhythmia suppression for symptoms or declining ventricular function suspected to be due to frequent premature ventricular complexes (generally 15% of beats and predominately of one morphology) and for whom antiarrhythmic medications are ineffective, not tolerated, or not the patients preference, catheter ablation is useful (Level I).

• #26 Ventricular tachycardia secondary prevention – wikidoc

  https://www.wikidoc.org/index.php/Ventricular_tachycardia_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 was superior to antiarrhythmic drugs 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, proarrhythmic medication effect may be corrected. […] ICD implantation improved outcome in well-tolerated VT and structurally heart disease. […] 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. […] 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.

• #27 2022 ESC Guidelines for Ventricular Arrhythmias: Key Points

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/09/02/14/23/2022-ESC-Guidelines-for-VAs-ESC-2022

  In sudden cardiac arrest survivors with coronary artery spasm, implantation of an ICD should be considered. […] ICD therapy should also be considered in patients with CAD, New York Heart Association class I, and left ventricular ejection fraction (LVEF) 30% despite 3 months of optimal medical therapy. […] Likewise, ICD implantation should be considered in patients with CAD, LVEF 40% despite 3 months of optimal medical therapy and nonsustained VT, if they are inducible for VT at electrophysiologic (EP) study. […] In patients with CAD and hemodynamically well tolerated SMVT and preserved or mildly reduced EF (i.e., LVEF 40%), catheter ablation should be considered as an alternative to ICD therapy, provided that the ablations established endpoints have been reached. […] Catheter ablation as first-line treatment is recommended for symptomatic idiopathic VT and premature ventricular contractions (PVCs) from the right ventricular outflow tract (RVOT) or the left fascicles.

• #28 Ventricular tachycardia secondary prevention – wikidoc

  https://www.wikidoc.org/index.php/Ventricular_tachycardia_secondary_prevention

  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. […] 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. […] In the presence of recurrent ventricular arrhythmia in spite of maximum doses of medications or survivors of SCA, implantation of ICD is recommended. […] In patients with ventricular arrhythmia due to coronary artery spasm, vasodilator such as calcium channel blocker with maximum tolerated doses smoking cessation and is recommended. […] In survival of SCA due to coronary artery spasm with ineffective or not tolerated medications, ICD implantation is recommended if the survival is more than 1 year.

• #29 2017 Guideline for Management of Ventricular Arrhythmias and Prevention of SCD

  https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/10/29/08/56/2017-guideline-for-management-of-patients-with-ventricular-arrhythmias

  In patients who meet criteria for an ICD who have inadequate vascular access or are at high risk for infection, and in whom pacing for bradycardia or VT termination or as part of cardiac resynchronization therapy is neither needed nor anticipated, a subcutaneous ICD is recommended (Level I). […] In first-degree relatives of SCD victims who were 40 years of age, cardiac evaluation is recommended, with genetic counseling and genetic testing performed as indicated by clinical findings (Level I). […] Patients considering implantation of a new ICD or replacement of an existing one should be informed of their individual risk of SCD and nonsudden death from HF or noncardiac conditions, and the effectiveness and potential complications of the ICD in light of their health goals, preferences, and values (Class I). In patients with refractory HF, refractory sustained VA, or nearing the end of life from other illness, clinicians should discuss ICD shock deactivation and consider the patients goals and preferences (Class I).

• #30 Catheter ablation for prevention of ventricular tachycardia | Nature Reviews Cardiology

  https://www.nature.com/articles/nrcardio.2010.17

  Patients with structural heart disease are at risk for life-threatening ventricular tachycardias (VTs). […] Catheter ablation for VT can reduce the need for ICD therapies and is an increasingly important adjunct to the treatment of these patients. […] Prophylactic catheter ablation for the prevention of defibrillator therapy.

• #31 Team Management of the Ventricular Tachycardia Patient | AER Journal

  https://www.aerjournal.com/articles/team-management-ventricular-tachycardia-patient?language_content_entity=en

  The use of overdrive or anti-tachycardia pacing (ATP) to terminate haemodynamically stable VTs before shocks has been shown to be effective, with similar rates of VT acceleration, VT duration, syncope and sudden death when compared to shock only. […] In patients with SHD and VT, antiarrhythmic drugs can be used in conjunction with ICD programming to minimise shocks. […] Beta-blockers have been shown to decrease mortality in patients with VT, heart failure and reduced EF, and are often used in the absence of contra-indications. […] Catheter ablation of VT has gained an increasingly prominent role in the management of many types of VT. […] The impact of catheter ablation has been studied in a variety of causes of VT. […] In the recent Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease (VANISH) trial, catheter ablation was also found to be superior to escalation of antiarrhythmic therapy in reducing the incidence of a composite primary endpoint of death, VT storm and appropriate ICD shocks.

• #32 Preventive ablation of ventricular tachycardia avoids shocks and hospitalisation

  https://www.escardio.org/The-ESC/Press-Office/Press-releases/preventive-ablation-of-ventricular-tachycardia-avoids-shocks-and-hospitalisation

  The first randomised trial to investigate preventive ablation of a potential arrhythmogenic substrate associated with coronary chronic total occlusion (CTO) in patients at high risk of ventricular arrhythmias (VAs) reduces the risk of appropriate implantable cardioverter-defibrillator (ICD) therapy and unplanned hospitalisation in patients with no previously recorded VAs. […] Our study shows that a primary prevention ablation strategy can be a safe and effective treatment option to prevent ICD interventions and arrhythmia-related hospitalisations. […] The PREVENTIVE VT trial investigated the impact of preventive VT ablation on ICD interventions in patients with ischaemic cardiomyopathy and infarct-related coronary CTO. […] Dr. Zizek said: Our study also highlights the importance of identifying ischaemic cardiomyopathy patients with a high risk of VAs in whom substrate ablation might prevent arrhythmias and consequent debilitating ICD shocks, while outweighing the potential for procedural complications.

• #33 Catheter ablation as first-line treatment for ventricular tachycardia in patients with structural heart disease and preserved left ventricular ejection fraction: a systematic review and meta-analysis | Scientific Reports

  https://www.nature.com/articles/s41598-024-69467-4

  Catheter ablation as the first-line treatment of VT in patients with sustained monomorphic ventricular tachycardia (SMVT), SHD, and a preserved left ventricular ejection fraction still remains unclear. […] This systematic review and meta-analysis evaluates the safety and efficacy of catheter ablation of VT as a first-line treatment in SHD patients with preserved LVEF. […] The primary outcome was the incidence of sudden cardiac death (SCD) after CA as the first-line treatment of VT in patients with structural heart disease and preserved left ventricular ejection fraction (LVEF). […] The overall pooled SCD and all-cause mortality incidence in our study were 3.1% (95% CI 1.75.6) and 5.0% (95% CI 1.813.0), respectively. […] The implementation of the ICD does not entirely prevent the occurrence of sudden cardiac death.

• #34 Catheter ablation as first-line treatment for ventricular tachycardia in patients with structural heart disease and preserved left ventricular ejection fraction: a systematic review and meta-analysis | Scientific Reports

  https://www.nature.com/articles/s41598-024-69467-4

  Based on the aforementioned incidence of SCD and mortality in the studies above, it seems that the incidence of SCD and all causes of mortality is considerably low in patients after catheter ablation without ICD implantation. […] The pooled VT recurrence based on the meta-analysis of our study was 23.2%. […] Based on our results, nearly six patients out of 100 experienced complications from catheter ablation without ICD implantation. […] The lower complication rate of catheter ablation in patients with SHD and preserved LVEF, rather than ICD implantation complication rates, may lead to the catheter ablation being considered as the first-line treatment in these patients. […] After catheter ablation as the first line in patients with SHD and preserved LVEF, only 13.9% needed ICD implantation after the catheter ablation procedure.

• #35 Catheter ablation as first-line treatment for ventricular tachycardia in patients with structural heart disease and preserved left ventricular ejection fraction: a systematic review and meta-analysis | Scientific Reports

  https://www.nature.com/articles/s41598-024-69467-4

  Based on this result and considering the high complication rates and cost of ICD implantation, it can be concluded that first-line catheter ablation of VT in patients with preserved LVEF is a proper therapeutic approach. […] Catheter ablation as the first line of VT treatment in patients with SHD and preserved LVEF appears to be a promising therapeutic option.

• #36 Antiarrhythmic drugs in acute ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation) – The Cardiovascular

  https://ecgwaves.com/docs/antiarrhythmic-drugs-in-acute-ventricular-arrhythmias-ventricular-tachycardia-ventricular-fibrillation/

  Acute coronary angiography should be considered in all patients with ventricular arrhythmias potentially caused by myocardial ischemia. Coronary angiography should also be considered in the following scenarios: New-onset ventricular arrhythmia in the absence of a clear (non-ischemic) cause. In patients developing ventricular arrhythmias after recently undergoing a coronary intervention (stent thrombosis is highly likely in these scenarios).

• #37 2022 ESC Guidelines for Ventricular Arrhythmias: Key Points

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/09/02/14/23/2022-ESC-Guidelines-for-VAs-ESC-2022

  Genetic testing is recommended in patients with dilated cardiomyopathy and atrioventricular (AV) conduction delay at 50 years of age, or those who have a family history of dilated cardiomyopathy or SCD in the first-degree relative (at age 50 years). […] CMR with late gadolinium enhancement (LGE) should be considered in dilated cardiomyopathy for assessing etiology and the risk of VA and SCD. […] ICD implantation should be considered in dilated cardiomyopathy and hypokinetic nondilated cardiomyopathy patients with an LVEF LMNA, PLN, FLNC, and RBM20 genes). […] In patients with suspected arrhythmogenic right ventricular cardiomyopathy (ARVC), CMR is recommended. […] ICD implantation should be considered in symptomatic patients with definite ARVC, moderate right or left ventricular dysfunction, and either nonsustained VT or inducibility of SMVT at EP study.

• #38 2022 ESC Guidelines for Ventricular Arrhythmias: Key Points

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/09/02/14/23/2022-ESC-Guidelines-for-VAs-ESC-2022

  ICD implantation should be considered in HCM patients with an intermediate 5-year risk of SCD, and with: a) significant LGE at CMR; or b) LVEF. […] In patients with LV noncompaction cardiomyopathy phenotype based on CMR or echo, implantation of an ICD for primary prevention of SCD should be considered to follow dilated cardiomyopathy recommendations. […] An ICD should be considered in patients with light chain amyloidosis or transthyretin-associated cardiac amyloidosis and hemodynamically not tolerated VT. […] EP study is recommended in patients with myotonic dystrophy and palpitations, syncope suggestive of VA, or surviving a cardiac arrest. […] ICD implantation is recommended in patients with myotonic dystrophy and SMVT or aborted cardiac arrest not caused by bundle branch re-entrant VT.

• #39

  https://link.springer.com/article/10.1007/s11886-000-0033-2

  Life-long therapy is necessary for patients with symptomatic long QT syndrome to prevent arrhythmic death. […] b-blockers remain the mainstay of therapy, but this medication may not be sufficient for cardiac arrest survivors and for those with the LQT3 genotype. […] Genotype-specific therapy, like potassium-channel openers for patients with inadequate potassium outflow (LQT1 and LQT2 genotypes) or sodium-channel blockers for patients with excessive sodium inflow (LQT3), significantly shortens the QT interval, but the effects of these drugs on arrhythmia prevention is less well established. […] Cardiac pacemakers may be especially beneficial for patients with LQT2 or LQT3 and for those with pause-dependent torsade de pointes. […] More important is to recognize that device programming for preventing tachyarrhythmias in patients with long QT differs from the standard pacemaker programming. […] Finally, implantable defibrillators with dual-chamber pacing capability are indicated for patients at high risk for arrhythmic death, including all cardiac arrest survivors.

• #40 Ventricular tachycardia secondary prevention – wikidoc

  https://www.wikidoc.org/index.php/Ventricular_tachycardia_secondary_prevention

  In survival of SCA due to coronary artery spasm, ICD implantation in addition to medical therapy is recommended if life expectancy is more than 1 year. […] ICD implantation is recommended in survivors of SCA or hemodynamically unstable VT or sustained VT not related to reversible causes, if life expectancy is more than 1 year. […] In the presence of syncope presumed due to ventricular arrhythmia, ICD or EPS study for risk stratification of SCD is recommended if survival is more than 1 year. […] In survival of SCA, or sustained VT, or symptomatic ventricular arrhythmia who are ineligible for ICD implantation due to limited life expectancy or inaccessible venous sites, amiodarone is recommended.

• #41 Team Management of the Ventricular Tachycardia Patient | AER Journal

  https://www.aerjournal.com/articles/team-management-ventricular-tachycardia-patient?language_content_entity=en

  Ventricular tachycardia is a common arrhythmia in patients with structural heart disease and heart failure, and is now seen more frequently as these patients survive longer with modern therapies. […] A coordinated team approach is therefore essential to achieve the best possible outcomes for these complex patients. […] Modern management of patients with ventricular arrhythmias requires a multidisciplinary team approach, especially in complex presentations with a background of multiple medical comorbidities. […] Antiarrhythmic medications, ICD implantation and catheter ablation are the cornerstones of current VT management. […] Caring for patients undergoing catheter ablation of VT in dedicated units with integrated multidisciplinary care has been shown to lead to improved outcomes. […] In patients with recurrent ICD shocks, reprogramming of ICDs by the EP team can help to minimise shocks.

• #42 Team Management of the Ventricular Tachycardia Patient | AER Journal

  https://www.aerjournal.com/articles/team-management-ventricular-tachycardia-patient?language_content_entity=en

  The use of overdrive or anti-tachycardia pacing (ATP) to terminate haemodynamically stable VTs before shocks has been shown to be effective, with similar rates of VT acceleration, VT duration, syncope and sudden death when compared to shock only. […] In patients with SHD and VT, antiarrhythmic drugs can be used in conjunction with ICD programming to minimise shocks. […] Beta-blockers have been shown to decrease mortality in patients with VT, heart failure and reduced EF, and are often used in the absence of contra-indications. […] Catheter ablation of VT has gained an increasingly prominent role in the management of many types of VT. […] The impact of catheter ablation has been studied in a variety of causes of VT. […] In the recent Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease (VANISH) trial, catheter ablation was also found to be superior to escalation of antiarrhythmic therapy in reducing the incidence of a composite primary endpoint of death, VT storm and appropriate ICD shocks.

• #43 2022 ESC Guidelines for Ventricular Arrhythmias: Key Points

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/09/02/14/23/2022-ESC-Guidelines-for-VAs-ESC-2022

  The following are key points to remember from the 2022 European Society of Cardiology (ESC) guidelines for the management of patients with ventricular arrhythmias (VAs) and the prevention of sudden cardiac death (SCD): […] It is recommended that public access to defibrillation is available at sites where cardiac arrest is more likely to occur and community training in basic life support is implemented to increase bystander cardiopulmonary resuscitation rate and automatic external defibrillator (AED) use. […] In patients with coronary artery disease (CAD) and a recurrent, symptomatic, sustained monomorphic ventricular tachycardia (SMVT), or implantable cardioverter-defibrillator (ICD) shocks for SMVT despite chronic amiodarone therapy, catheter ablation is recommended in preference to escalating antiarrhythmic drug therapy.

• #44 Sudden Cardiac Death and Ventricular Arrhythmias: New Guidelines, New Perspectives | ECR Journal

  https://www.ecrjournal.com/articles/comment-esc-guidelines-2022-management-patients-ventricular-arrhythmias-and-prevention?language_content_entity=en

  The European Society of Cardiology guidelines for the management of sudden cardiac death and ventricular arrhythmias have been updated. […] New conditions in secondary prevention are now open for discussion in terms of VA ablation as a potential solution. […] Genetic testing is highlighted as a powerful tool for diagnosis and stratification of risk depending on the nature of the pathology. […] No less important, the guidelines promote for the first time, with the highest recommendation (class I), the usefulness of community training in basic life support (e.g. to children at school with repeated programmes) and, by virtue of their potential benefits, automated external defibrillators being accessible at sites where cardiac arrest is more likely to occur.

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