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Atrial fibrillation ablation-new techniques,Meet the experts-arrhythmia

Sudden cardiac death (SCD) usually results from ventricular fibrillation (VF). Underlying heart disease is present in the vast majority of patients with SCD.

Most individuals suffering from SCD become unconscious within seconds to minutes. There are usually no premonitory symptoms. Prediction of SCD is a necessary prerequisite for effective prevention and therapy. This Symposium (chaired by P J Schwartz and P P Adragao) evaluated the importance of ICDs in selected patients with genetic disorders who are deemed to be at high risk for life-threatening VT/VF, in spite of usually having a normal LVEF.

Arrhythmias


The presenters discussed the most relevant aspects to identify patients at higher risk of SCD, who are candidates to implant an ICD.

C. Wolpert (DE) - Right ventricular cardiomyopathy
J. Brugada (SP) – Brugada syndrome
S G Priori (IT) – Long QT (LQT) syndrome
and S. P. Elliott (UK) – Hypertrophic cardiomyopathy

Patients who suffered an aborted SCD or had life threatening arrhythmias or related symptoms (syncope), under optimal medical therapy, were accepted to have a consensual indication for ICD implantation.
Right ventricular dysplasia needs to be treated based on clinical evaluation, and it is not possible today to stratify patients only based on gene test, Wolpert concluded.

According to J. Brugada, programmed ventricular stimulation discriminates higher risk asymptomatic Brugada syndrome patients.

Asymptomatic LQT 2 and 3 patients and those with a QT interval > 500ms under betablockers are subgroups of higher risk, pointed S Priori. Asymptomatic hypertrophic cardiomyopathy patients need to have additional risk factors to indicate an ICD such as septal thickness > 30mm, abnormal exercise blood pressure, non sustained VT, or family history of premature SCD.

Elliott stated that the indication will be stronger if the patient has multiple risk factors.

Sudden cardiac death (SCD) usually results from ventricular fibrillation (VF). Underlying heart disease is present in the vast majority of patients with SCD.

Most individuals suffering from SCD become unconscious within seconds to minutes. There are usually no premonitory symptoms. Prediction of SCD is a necessary prerequisite for effective prevention and therapy. This Symposium (chaired by P J Schwartz and P P Adragao) evaluated the importance of ICDs in selected patients with genetic disorders who are deemed to be at high risk for life-threatening VT/VF, in spite of usually having a normal LVEF.

Conclusion:

ICD for secondary prevention of SCD is commonly accepted in genetic arrhythmias. It is difficult to accurately identify patients needing primary prevention. It is not yet possible to use gene testing results as an independent risk marker strong enough to define treatment strategy, but they are useful combined with other clinical parameters.

References


1624-1627

SessionTitle:

When to use the implantable cardioverter-defibrillator in genetic arrhythmias

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.