• |
    • Sudden Cardiac Death & Ventricular Arrhythmias
    2022 ESC Guidelines Review
    focus on CAD & DCM/HNDCM
    link to 2022 ESC Guidelines for SCD/VA
    LVEF & NYHA
    for SCD riks stratification
    LVEF & NYHA
    remain the 2 key parameters for SCD risk stratifications.
    LVEF & NYHA are strongly associated with SCD risks.
    And treatment according to these 2 parameters reduce mortality. See MADIT II and SCD-HeFT for examples.
    Impaired LVEF after MI
    inversely correlates with risk of SCD.

    ICD is recommended in post MI with LVEF ≤30%, after optimal medical treatment (OMT), regardless of symptoms.

    VALIANT Trial NEJM 2005.
    Majority of deaths in NYHA II & III are caused by SCD.
    ICD is recommended in LVEF≤35% and NYHA II or III with several underlying cardiac conditions.
    Noted that the level of recommendation of ICD for DCM with LVEF≤35% and NYHA II or III was downgraded from I to IIa in response to the result of DANISH trial.

    MERIT-HF. Lancet 1999.
    BEYOND LVEF & NYHA
    ˙Programmed Electrical Stimulation (PES)
    ˙Cardiac MRI
    ˙Genetic Testing
    ˙SCD Risk Score
    PES
    is indicated in post MI patients with unexplained syncope who do not meet other criteria for ICD.
    PES is useful for further risk stratifications after unexplained syncope in...
    ˙Ischemic Cardiomyopathy, Neuromuscular Disease
    ˙DCM/HNDCM, ARVC, Sarcoidosis, Congenital Heart Disease
    ˙Brugada Syndrome

    color denotes class of recommendation.
    2022 ESC Guidelines for SCD/VA
    ETIOLOGIES OF DCM/HNDCM
    are widely variable among different population.
    NEJM 2000
    Ramathibodi Medical Journal, 37(4), 176–182.
    Genetic Mutation in DCM & SCD Risks
    Certain genetic mutations in DCM/HNDCM are associated with higher SCD risks.
    Clin Res Cardiol. 2017.
    LGE in MRI and SCD Risks
    Circulation 2021.
    MRI in diagnosis and risk stratification
    ˙Survivor of SCA w/o clear causes (after Echo), ARVC, HCM
    ˙DCM/HNDCM, Suspected PVC-induced cardiomyopathy, LVNC, Neuromuscular Disease, Sarcoidosis
    color denotes class of recommendation. 2022 ESC Guidelines for SCD/VA
    RISK SCORE FOR LMNA DCM/HNDCM
    Consider ICD in LMNA Mutation + Estimate 5-yr VA risk ≥10% (IIA)
    link to LMNA Risk Score
    CATHERTER ABLATION OF VENTRICULAR TACHYCARDIA
    In CAD, ablation is indicated in patients with recurrent VTs after ICD and Amiodarone. This recommendation came as a result of VANISH trial. The trial showed that VT ablation was associated with better clinical outcomes than escalation in antiarrhythmic therapy.
    VT ABLATION in non-Ischemic Cardiomyopathy
    Data is less robust. Highest class of recommendation is IIa
    IDIOPATHIC PVC/VT
    Consider cardiac MRI for Atypical Presentation, i.e. older age, RBBB morphology. (IIa)
    EVALUATION OF
    SCA Survivors
    BENEFIT OF ICD
    is not seen right away. It would need almost a year to see the difference.
    MADIT II and EU-CERT-ICD
    to top
    HeartRhythmBox, an education page of heart rhythm topics.
    visit us at www.heartrhythmbox.com
    or https://www.facebook.com/HeartRhythmBox/
    SCD Animation