2017 Guideline for Management of Ventricular Arrhythmias and Prevention of SCD

Authors:
Al-Khatib SM, Stevenson WG, Ackerman MJ, et al.
Citation:
2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2017;Oct 30:[Epub ahead of print].

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):

  1. 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).
  2. 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).
  3. In patients with nonischemic cardiomyopathy, HF with New York Heart Association class II–III 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.
  4. 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.
  5. In young patients (<40 years of age) with unexplained SCD, unexplained near drowning, or recurrent exertional syncope, who do not have ischemic or other structural heart disease, further evaluation for genetic arrhythmia syndromes is recommended (Class I).
  6. 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 patient’s preference, catheter ablation is useful (Level I).
  7. 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).
  8. 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).
  9. 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).

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Sports and Exercise Cardiology, Valvular Heart Disease, Vascular Medicine, Implantable Devices, EP Basic Science, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD & Pediatrics, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Congenital Heart Disease, CHD & Pediatrics and Arrhythmias, CHD & Pediatrics and Imaging, CHD & Pediatrics and Interventions, CHD & Pediatrics and Prevention, CHD & Pediatrics and Quality Improvement, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Mechanical Circulatory Support , Interventions and Imaging, Interventions and Structural Heart Disease, Interventions and Vascular Medicine, Angiography, Echocardiography/Ultrasound, Magnetic Resonance Imaging, Nuclear Imaging, Sports & Exercise and Congenital Heart Disease & Pediatric Cardiology, Sports & Exercise and ECG & Stress Testing, Sports & Exercise and Imaging

Keywords: Ablation Techniques, Angiography, Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Antagonists, Anti-Arrhythmia Agents, Arrhythmias, Cardiac, Arrhythmogenic Right Ventricular Dysplasia, Athletes, Autonomic Nervous System, Biological Markers, Cardiac Electrophysiology, Cardiac Imaging Techniques, Cardiac Resynchronization Therapy, Cardiomyopathies, Cardiomyopathy, Hypertrophic, Catheter Ablation, Channelopathies, Cost-Benefit Analysis, Death, Sudden, Cardiac, Defibrillators, Implantable, Electrocardiography, Ambulatory, Electrocardiography, Echocardiography, Electrophysiologic Techniques, Cardiac, Exercise Test, Genetics, Genetic Diseases, Inborn, Guideline, Heart Arrest, Heart-Assist Devices, Heart Defects, Congenital, Heart Failure, Heart Valve Diseases, Medical History Taking, Magnetic Resonance Imaging, Mineralocorticoid Receptor Antagonists, Myocardial Infarction, Myocardial Ischemia, Myocarditis, Peripheral Vascular Diseases, Pregnancy, Primary Prevention, Risk Factors, Sarcoidosis, Subcutaneous Tissue, Syncope, Tachycardia, Ventricular, Therapeutics, Vascular Surgical Procedures, Ventricular Fibrillation, Bradycardia


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