Ventricular tachycardia primary prevention: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Ventricular tachycardia}} | {{Ventricular tachycardia}} | ||
{{CMG}}; '''Associate Editor-In-Chief:''' {{Sara.Zand}} | |||
==Overview== | |||
[[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 is not survival benefit of [[ICD]] implantation in [[patients]] with [[NYHA]] class IV [[heart failure]]. | |||
==[[Primary Prevention]]== | ==[[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. | * [[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.<ref name="HohnloserKuck2004">{{cite journal|last1=Hohnloser|first1=Stefan H.|last2=Kuck|first2=Karl Heinz|last3=Dorian|first3=Paul|last4=Roberts|first4=Robin S.|last5=Hampton|first5=John R.|last6=Hatala|first6=Robert|last7=Fain|first7=Eric|last8=Gent|first8=Michael|last9=Connolly|first9=Stuart J.|title=Prophylactic Use of an Implantable Cardioverter–Defibrillator after Acute Myocardial Infarction|journal=New England Journal of Medicine|volume=351|issue=24|year=2004|pages=2481–2488|issn=0028-4793|doi=10.1056/NEJMoa041489}}</ref> | ||
* 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]]. | * In [[patients]] with [[LVEF ]] ≤30% and prior [[MI ]] and [[NYHA]] class I symptoms , [[ICD]] implantation was associated with survival benefit.<ref name="SteinbeckAndresen2009">{{cite journal|last1=Steinbeck|first1=Gerhard|last2=Andresen|first2=Dietrich|last3=Seidl|first3=Karlheinz|last4=Brachmann|first4=Johannes|last5=Hoffmann|first5=Ellen|last6=Wojciechowski|first6=Dariusz|last7=Kornacewicz-Jach|first7=Zdzisława|last8=Sredniawa|first8=Beata|last9=Lupkovics|first9=Géza|last10=Hofgärtner|first10=Franz|last11=Lubinski|first11=Andrzej|last12=Rosenqvist|first12=Mårten|last13=Habets|first13=Alphonsus|last14=Wegscheider|first14=Karl|last15=Senges|first15=Jochen|title=Defibrillator Implantation Early after Myocardial Infarction|journal=New England Journal of Medicine|volume=361|issue=15|year=2009|pages=1427–1436|issn=0028-4793|doi=10.1056/NEJMoa0901889}}</ref> | ||
* There was not survival benefit of [[ICD]] implantation in [[patients]] with [[NYHA]] class IV [[heart failure]]. | |||
* 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]].<ref name="BristowSaxon2004">{{cite journal|last1=Bristow|first1=Michael R.|last2=Saxon|first2=Leslie A.|last3=Boehmer|first3=John|last4=Krueger|first4=Steven|last5=Kass|first5=David A.|last6=De Marco|first6=Teresa|last7=Carson|first7=Peter|last8=DiCarlo|first8=Lorenzo|last9=DeMets|first9=David|last10=White|first10=Bill G.|last11=DeVries|first11=Dale W.|last12=Feldman|first12=Arthur M.|title=Cardiac-Resynchronization Therapy with or without an Implantable Defibrillator in Advanced Chronic Heart Failure|journal=New England Journal of Medicine|volume=350|issue=21|year=2004|pages=2140–2150|issn=0028-4793|doi=10.1056/NEJMoa032423}}</ref> | |||
{| style="cellpadding=0; cellspacing= 0; width: 600px;" | |||
|- | |||
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Recommendations for primary prevention of sudden cardiac death in ischemic heart disease''' | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | '''[[ICD]] implantation ([[ACC AHA guidelines classification scheme|Class I, Level of Evidence A]]):''' | |||
|- | |||
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left| | |||
❑ 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 <br> | |||
❑ In patients with [[LVEF]]≤ 30% and [[NYHA]] class 1 [[heart failure]] despite medical therapy at least 40 days post [[MI]] or 90 days [[postrevascularization]] with life expectancy > 1 year | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[ICD]] implantation ([[ACC AHA guidelines classification scheme|Class I, Level of Evidence B]]) :''' | |||
|- | |||
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left| | |||
❑ In patients with [[LVEF]] ≤ 40% and nonsustained [[VT]] due to prior [[MI]] or [[VT]] ,[[VF]] inducible in [[EPS]] with life expectancy >1 year<br> | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[ICD implantation]] : ([[ACC AHA guidelines classification scheme|Class IIa, Level of Evidence B]])''' | |||
|- | |||
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left| | |||
❑ In patients with [[NYHA]] class 4 who are candidates for cardiac transplantation or [[LVAD]] with life expectancy > 1 year | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''([[ACC AHA guidelines classification scheme|Class III, Level of Evidence C]])''' | |||
|- | |||
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left| | |||
❑ [[ICD ]] is not beneficial in patients with [[NYHA]] class 4 despite optimal medical therapy who are not candidates for [[cardiac transplantation]] or [[LVAD]] | |||
|- | |||
|} | |||
<span style="font-size:85%">'''Abbreviations:''' | <span style="font-size:85%">'''Abbreviations:''' | ||
'''MI:''' [[Myocardial infarction]]; | '''MI:''' [[Myocardial infarction]]; | ||
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</span> | </span> | ||
<br> | <br> | ||
{| | |||
! colspan="2" style="background: PapayaWhip;" align="center" + |The above table adopted from 2017 AHA/ACC/HRS Guideline | |||
|- | |||
|}<ref name="Al-KhatibStevenson2018">{{cite journal|last1=Al-Khatib|first1=Sana M.|last2=Stevenson|first2=William G.|last3=Ackerman|first3=Michael J.|last4=Bryant|first4=William J.|last5=Callans|first5=David J.|last6=Curtis|first6=Anne B.|last7=Deal|first7=Barbara J.|last8=Dickfeld|first8=Timm|last9=Field|first9=Michael E.|last10=Fonarow|first10=Gregg C.|last11=Gillis|first11=Anne M.|last12=Granger|first12=Christopher B.|last13=Hammill|first13=Stephen C.|last14=Hlatky|first14=Mark A.|last15=Joglar|first15=José A.|last16=Kay|first16=G. Neal|last17=Matlock|first17=Daniel D.|last18=Myerburg|first18=Robert J.|last19=Page|first19=Richard L.|title=2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death|journal=Circulation|volume=138|issue=13|year=2018|issn=0009-7322|doi=10.1161/CIR.0000000000000549}}</ref> | |||
{| style="cellpadding=0; cellspacing= 0; width: 600px;" | {| style="cellpadding=0; cellspacing= 0; width: 600px;" | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Recommendations for primary prevention of sudden cardiac death in ischemic heart disease''' | | style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Recommendations for primary prevention of sudden cardiac death in non-ischemic heart disease''' | ||
|- | |- | ||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | '''[[ICD]] implantation ([[ACC AHA guidelines classification scheme|Class I, Level of Evidence A]]):''' | |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | '''[[ICD]] implantation ([[ACC AHA guidelines classification scheme|Class I, Level of Evidence A]]):''' | ||
|- | |- | ||
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left| | |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left| | ||
❑ In patients with [[LVEF]]≤ 35% and [[NYHA]] class 2,3 [[heart failure]] despite medical therapy | ❑ In patients with [[LVEF]]≤ 35% and [[NYHA]] class 2,3 [[heart failure]] despite medical therapy with survival > 1 year<br> | ||
|- | |- | ||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[ICD]] implantation ([[ACC AHA guidelines classification scheme|Class | |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[ICD]] implantation ([[ACC AHA guidelines classification scheme|Class IIa, Level of Evidence B]]) :''' | ||
|- | |- | ||
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left| | |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left| | ||
❑ In | ❑ 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<br> | ||
|- | |- | ||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[ICD implantation]] : ([[ACC AHA guidelines classification scheme|Class | |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[ICD implantation]] : ([[ACC AHA guidelines classification scheme|Class IIb, Level of Evidence B]])''' | ||
|- | |- | ||
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left| | |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left| | ||
❑ In patients with [[NYHA]] class | ❑ In patients with [[NYHA]] class 1 [[heart failure]] and [[LVEF]] <35% despite optimal medical therapy, [[ICD]] is recommended if life expectancy>1 year<br> | ||
|- | |- | ||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''([[ACC AHA guidelines classification scheme|Class III, Level of Evidence C]])''' | |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''([[ACC AHA guidelines classification scheme|Class III, Level of Evidence C]])''' | ||
|- | |- | ||
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left| | |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left| | ||
❑ [[ICD ]] is not beneficial in patients with [[NYHA]] class 4 despite optimal medical therapy who are not candidates for [[cardiac transplantation]] or [[LVAD]] | ❑ [[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<br> | ||
|- | |- | ||
|} | |} | ||
<span style="font-size:85%">'''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]] | |||
</span> | |||
<br> | |||
{| | |||
! colspan="2" style="background: PapayaWhip;" align="center" + |The above table adopted from 2017 AHA/ACC/HRS Guideline | |||
|- | |||
|}<ref name="Al-KhatibStevenson2018">{{cite journal|last1=Al-Khatib|first1=Sana M.|last2=Stevenson|first2=William G.|last3=Ackerman|first3=Michael J.|last4=Bryant|first4=William J.|last5=Callans|first5=David J.|last6=Curtis|first6=Anne B.|last7=Deal|first7=Barbara J.|last8=Dickfeld|first8=Timm|last9=Field|first9=Michael E.|last10=Fonarow|first10=Gregg C.|last11=Gillis|first11=Anne M.|last12=Granger|first12=Christopher B.|last13=Hammill|first13=Stephen C.|last14=Hlatky|first14=Mark A.|last15=Joglar|first15=José A.|last16=Kay|first16=G. Neal|last17=Matlock|first17=Daniel D.|last18=Myerburg|first18=Robert J.|last19=Page|first19=Richard L.|title=2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death|journal=Circulation|volume=138|issue=13|year=2018|issn=0009-7322|doi=10.1161/CIR.0000000000000549}}</ref> | |||
==References== | ==References== | ||
Latest revision as of 09:06, 27 May 2021
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Ventricular tachycardia Microchapters |
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Differentiating Ventricular Tachycardia from other Disorders |
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Ventricular tachycardia primary prevention On the Web |
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to Hospitals Treating Ventricular tachycardia primary prevention |
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Risk calculators and risk factors for Ventricular tachycardia primary prevention |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Sara Zand, M.D.[2]
Overview
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 is not survival benefit of ICD implantation in patients with NYHA class IV heart failure.
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): |
|
❑ 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) : |
|
❑ 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) |
|
❑ 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) |
|
❑ 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 |
|---|
| Recommendations for primary prevention of sudden cardiac death in non-ischemic heart disease |
| ICD implantation (Class I, Level of Evidence A): |
|
❑ 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) : |
|
❑ 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) |
|
❑ 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) |
|
❑ 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 |
|---|
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.
- ↑ 4.0 4.1 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". Circulation. 138 (13). doi:10.1161/CIR.0000000000000549. ISSN 0009-7322.