Catecholaminergic polymorphic ventricular tachycardia implantable cardioverter-defibrillator
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mounika Reddy Vadiyala, M.B.B.S.[2]
Overview
Implantable cardioverter defibrillator should be used with pharmacologic therapy. It is recommended in patients who are at high risk of cardiac arrest, patients who have survived a sudden cardiac arrest and patients who have experienced syncope or sustained VT despite optimal medical therapy.
Implantable Cardioverter-Defibrillator
- Implantable cardioverter defibrillator should be used with pharmacologic therapy.[1]
- Indications:[2]
- Patients who are at high risk of cardiac arrest
- Patients who have survived a sudden cardiac arrest
- Patients who have experienced syncope or sustained VT despite optimal medical therapy and left cardiac sympathetic denervation. [].
- Implantable cardioverter-defibrillator may have harmful pro-arrhythmic effects in some patients, since painful shocks can increase catecholamine release and trigger further arrhythmias and triggering VT storm, leading to a malignant cycle of shocks that may even culminate in death.
- To reduce the risk of inappropriate shocks, it is important to program ICD with long delays before shock delivery and high cut-off rates for heart rate recognition; and always administer beta blockers concurrently.[3]
2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT)[3]
| Class I |
| "1.In patients with catecholaminergic polymorphic ventricular tachycardia, a beta blocker is recommended.(Level of Evidence: B)" |
| "2.In patients with catecholaminergic polymorphic ventricular tachycardia and recurrent sustained VT or syncope, while receiving adequate or maximally tolerated beta blocker, treatment intensification with either combination medication therapy (e.g., beta blocker, flecainide), left cardiac sympathetic denervation, and/or an ICD is recommended (Level of Evidence: B)" |
| Class IIa |
| "1.In patients with catecholaminergic polymorphic ventricular tachycardia and with clinical VT or exceptional syncope, genetic counseling and genetic testing are reasonable (Level of Evidence: B)" |
References
- ↑ Roston, Thomas M.; Jones, Karolina; Hawkins, Nathaniel M.; Bos, J. Martijn; Schwartz, Peter J.; Perry, Frances; Ackerman, Michael J.; Laksman, Zachary W.M.; Kaul, Padma; Lieve, Krystien V.V.; Atallah, Joseph; Krahn, Andrew D.; Sanatani, Shubhayan (2018). "Implantable cardioverter-defibrillator use in catecholaminergic polymorphic ventricular tachycardia: A systematic review". Heart Rhythm. 15 (12): 1791–1799. doi:10.1016/j.hrthm.2018.06.046. ISSN 1547-5271.
- ↑ Priori, Silvia G.; Blomström-Lundqvist, Carina; Mazzanti, Andrea; Blom, Nico; Borggrefe, Martin; Camm, John; Elliott, Perry Mark; Fitzsimons, Donna; Hatala, Robert; Hindricks, Gerhard; Kirchhof, Paulus; Kjeldsen, Keld; Kuck, Karl-Heinz; Hernandez-Madrid, Antonio; Nikolaou, Nikolaos; Norekvål, Tone M.; Spaulding, Christian; Van Veldhuisen, Dirk J. (2015). "2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death". European Heart Journal. 36 (41): 2793–2867. doi:10.1093/eurheartj/ehv316. ISSN 0195-668X.
- ↑ 3.0 3.1 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". Journal of the American College of Cardiology. 72 (14): e91–e220. doi:10.1016/j.jacc.2017.10.054. ISSN 0735-1097.