Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (ACC/AHA/ESC 2006 Guidelines for Management of Patients With)

Topics: Arrhythmias

Authors

Table of contents: Full Text (ESC Clinical Practice Guidelines)

Introduction

• Prophylactic implantable cardioverterdefibrillator recommendations across published guidelines, Classification of ventricular arrhythmias and sudden cardiac death

Epidemiology

• Ventricular arrhythmias:
  Premature ventricular complexes and nonsustained ventricular tachycardia, Premature ventricular complexes in the absence of heart disease, Premature ventricular complexes in the presence of established heart disease, Ventricular tachycardia and ventricular fibrillation during acute coronary syndromes
• Sudden cardiac death:
  Incidence of sudden cardiac death, Population subgroups and risk prediction, Time-dependent risk, Age, heredity, gender, and race, Risk profiles and sudden cardiac death

Mechanisms and substrates

• Substrate for ventricular arrhythmias, Mechanisms of sudden cardiac death

Clinical presentations of patients with ventricular arrhythmias and sudden cardiac death

• Asymptomatic
• Symptoms potentially related to ventricular arrhythmias: Hemodynamically stable ventricular tachycardia, Hemodynamically unstable ventricular tachycardia
• Sudden cardiac arrest 

General evaluation of patients with documented or suspected ventricular arrhythmias

• History and physical examination
• Noninvasive evaluation:
  • Resting electrocardiogram
  • Exercise testing
  • Ambulatory electrocardiography
  • Electrocardiographic techniques and measurements
  • Left ventricular function and imaging
• Electrophysiological testing
  • Electrophysiological testing in patients with coronary heart diseases
  • Electrophysiological testing in patients with dilated cardiomyopathy
  • Electrophysiological testing in repolarization anomalies due to genetic arrhythmia syndromes, Long QT syndrome, Brugada syndrome, Hypertrophic cardiomyopathy, Arrhythmogenic right ventricular cardiomyopathy
  • Electrophysiological testing in patients with outflow tract ventricular tachycardia
  • Electrophysiological testing in patients with syncope

Therapies for ventricular arrhythmias

• General management
• Drug therapy
• Antiarrhythmic drugs
• Nonantiarrhythmic drugs
• Implantable and external cardioverter devices
• Ablation
• Surgery and revascularization procedures

Acute management of specific arrhythmias

• Management of cardiac arrest
• Sustained monomorphic ventricular tachycardia
• Repetitive monomorphic ventricular tachycardia
• Polymorphic VT
• Torsades de pointes
• Incessant ventricular tachycardia

Ventricular arrhythmia and sudden cardiac death related to specific pathology

• Left ventricular dysfunction due to prior myocardial infarction
• Valvular heart disease
• Congenital heart disease
• Pericardial diseases
• Pulmonary arterial hypertension
• Transient arrhythmias of reversible cause

Ventricular arrhythmias associated with cardiomyopathies

• Dilated cardiomyopathy (nonischemic)
• Hypertrophic cardiomyopathy
• Arrhythmogenic right ventricular cardiomyopathy
• Neuromuscular disorders

Heart failure

Genetic arrhythmia syndromes

• General concepts for risk stratification:
  • Long QT syndrome
  • Short QT syndrome
  • Brugada syndrome
  • Catecholaminergic polymorphic ventricular tachycardia

Arrhythmias in structurally normal hearts

• Idiopathic ventricular tachycardia
• Electrolyte disturbances
• Physical and toxic agents

Ventricular arrhythmias and sudden cardiac death related to specific populations

• Athletes
• Gender and pregnancy
• Elderly patients
• Pediatric patients
• Patients with implantable cardioverterdefibrillators
• Drug-induced arrhythmias