Ventricular Arrhythmias and Sudden Cardiac Death - CardioSource

60 Pages·2006·0.85 MB·English

Learn and LiveSM
ACC/AHA/ESC Pocket Guideline
Based on the ACC/AHA/ESC
2006 Guidelines
Management
of Patients With
Ventricular
Arrhythmias and
the Prevention of
Sudden Cardiac
Death
September 2006
Special thanks to
Distributed through support
from Medtronic Inc.
Medtronic Inc.
was not involved in the
development of this
publication and
in no way influenced
its contents.
Management
of Patients With Introduction
Ventricular
Arrhythmias and
the Prevention of
Sudden Cardiac
Death
September 2006
ACC/AHA/ESC Writing Committee
Douglas P. Zipes, MD, MACC, FAHA, FESC, Co-Chair
A. John Camm, MD, FACC, FAHA, FESC, Co-Chair
Martin Borggrefe, MD, FESC
Alfred E. Buxton, MD, FACC, FAHA
Bernard Chaitman, MD, FACC, FAHA
MGaabrtriine lF Groremgeorr,a MtoDs, MD, FACC, FAHA Therapies
George Klein, MD, FACC
Arthur J. Moss, MD, FACC, FAHA
Robert J. Myerburg, MD, FACC, FAHA
Silvia G. Priori, MD, PhD, FESC
Miguel A. Quinones, MD, FACC A
Dan M. Roden, MD, CM, FACC, FAHA cute M
MCyinchthaieal TJ.r aScilyk,a M, MD,D F,A FCACC,C F,A FHAAHA anagem
ent
i
Introduction
© 2006 American College of Cardiology Foundation,
American Heart Association, Inc., and the European
Society of Cardiology.
The following material was adapted from the ACC/
AHA/ESC 2006 Guidelines for the Management of Patients
With Ventricular Arrhythmias and the Prevention of
Sudden Cardiac Death: Executive Summary (Journal
of the American College of Cardiology 2006; 48:1064–
1108, Circulation 2006; 114:1088-1132, and European
Heart Journal 2006; 27:2099–2140).
For a copy of the full report or published executive
summary, visit our Web sites at http://www.acc.org,
http://www.americanheart.org, or http://www.escardio.org
or call the ACC Resource Center at 1-800-253-4636,
ext. 694.
ii
Contents
IAB. ..I CnRPrlteaorcsoposdhmifyuimclcaatcetitinooicdnn a I mt.oi.fop .Vnl.ase.n nA.ttac.ribr.col.ues.l saC. rP.a u.Ard.bri.rloih.svy.het.erh.tdme. Gr.i aDu.s.ie d.ave.nilc.idne. Se. su. d..d....e..n.. C..a..r..d..i..a..c.. D..e..a..t..h.. ..............1490 Introduction
II. Incidence of Sudden Cardiac Death ............................. 11
SCD
IVIeI.n Ctlriinciuclaalr P Arerrsheyntthamtiioanss a onfd P Sautidednetns WCaitrhd i ac Death ................ 11 Clin. Presentation
IV. General Evaluation of Patients With
DABCD....o EAERcxluemeesmcbrtticuerniolsngace ttEa oeTrlrdeedycs i oottEirgrnloe rSgcac ua.tmr.rsod .pTci.eoea.cgcr.tdhr.eaino.mdig.q Vr..ua..eep..nsh.. tay..rn i...cd...u ...Ml...ae...ra... As...ur...rr...eh...my...t...eh...nm...ts...i ....a....s.... ................................................................................ 1111122344 Patient EvaluationPatient Evaluation
E. Left Ventricular Function and Imaging ............................. 15
F. Electrophysiological Testing ...................................... 16
VAB... TAInhbtelraortadiopunice t.iso. fn.o ..r.. V..e....n..t..ri..c..u..l..a..r.. A..r..r..h..y..t..h..m....i..a..s.. .............................................................................. 111888 Therapies
VI. Acute Management of Specific Arrhythmias .................... 20
A. Management of Cardiac Arrest ................................... 20
B. Ventricular Tachycardia Associated With Low Troponin MI ............ 21 A
CDEFG..... TPSRIonouerclspsyeteamastdsiinoetairesnvp detdh VeMMic ePo onVonnteiroonnimcmtteuroosilca rr.uprp. lhhTa.iiar.cc c .T VVh.aeye.cncn.hatt.yrrr.ciidcca.iuua.rldl ..aai..rar .. TT...aa...cc...hh...yy...cc...aa...rrd...d...iiaa... .................................................................................................... 2222223346 cute Management
Introduction
2
VII. Ventricular Arrhythmias and Sudden
CABCD..a.. VCPrLdeeoairflnatvi cgucVae leDrandnrieti taHarailletc DHhau rileRsata ereDr aDtli sasDyeetsiseasf duse.ena .t sc..oet.. i So...np...... eD...cu...ife...i ...ct... oP... Pa...rt...iho...o...r l...Mo...gI... y........ .............................................................................................................. 2233377002 IntroductionSpecific PathologySpecific Pathology
E. Pulmonary Arterial Hypertension .................................. 32
F. Transient Arrhythmias of Reversible Cause .......................... 33
VAI. IDI. iVlaetendtr Cicaurdlaior mAyrrohpyatthhym (iNaosn Aisscshoecmiaitce) d. .W..it.h. .C.a.r.d.i.o.m..y.o.p.a.t.h.i.e.s. ........ 3344 Cardiom
BC.. HAyrrpheyrtthrompohgice nCiacr Rdiioghmt yVoepnattrhicyu .la..r .C.a.r.d.io.m..y.o.p.a.t.h.y. .................................... 3368 yopathies
H
IX. Heart Failure ................................................. 39 eart Failure
X. Genetic Arrhythmia Syndromes ................................ 42
G
AB.. BLorungga QdaT SSyynnddrroommee .......................................................................................... 4423 enetic A
C. Catecholaminergic Polymorphic Ventricular Tachycardia .............. 45 rrhythm
ia
XI. Ventricular Arrhythmias and Sudden
Cardiac Death Related to Specific Populations ..................... 46
A. Athletes ...................................................... 46
BCDE.... DGEPlaredutneigedr-nleIytnr s Pda Wauntcdiieet hPnd r tIAesm gr.prn.hlaa.ynn.tcht.aym. b..ila..es.. C ...a...r...d...i...o...v...e...rt...e...r... D...e...v...i...c...e...s... .................................................................................... 44447789 Specific Populations
I. Introduction
Introduction Ttehxet ,r feigaudreers s, haonudl dta nboletes tinhcaltu tdheed r einc othmemsee pnodcaktieotn s,
guidelines represent a succinct summary of the
more extensive evidence base, critical evaluation,
supporting text, tables, figures, and references that
are included in the full-text guidelines. Readers are
strongly encouraged to refer to the full-text
guidelines.
Classification of Recommendations and Level of
Evidence are expressed in the American College of
Cardiology (ACC)/American Heart Association
(AHA)/European Society of Cardiology (ESC) format
as follows:
4
Classification of Recommendations
Class I Conditions for which there is evidence and/or Introduction
general agreement that a given procedure or
treatment is beneficial, useful, and effective.
Class II Conditions for which there is conflicting evidence
and/or divergence of opinion about the usefulness/
efficacy of a procedure or treatment.
Class IIa Weight of evidence/opinion is in favor of
usefulness/efficacy.
Class IIb Usefulness/efficacy is less well established
by evidence/opinion.
Class III Conditions for which there is evidence and/or
general agreement that a procedure/treatment is
not useful/effective and in some cases may be
harmful.
Level of Level of Evidence A Data derived from multiple
Evidence randomized clinical trials or meta-analyses.
Level of Evidence B Data derived from a single
randomized trial or nonrandomized studies.
Level of Evidence C Only consensus opinion of
experts, case studies, or standard-of-care.
The schema for classification of recommendations
and level of evidence is summarized in Table 1.
5
Table 1. Applying Classification of
Introduction Recommendations and Level of Evidence†
SIZE OF TREATMENT EFFECT
CLASS I CLASS IIA Class IIb Class III
Benefit >>> Risk Benefit >> Risk Benefit ≥ Risk Risk ≥ Benefit
Procedure/Treatment Additional studies with Additional studies with broad No additional studies needed
SHOULD be performed/ focused objectives needed objectives needed; additional Procedure/Treatment should
administered IT IS REASONABLE to per- registry data would be helpful NOT be performed/adminis-
form procedure/administer Procedure/Treatment tered SINCE IT IS NOT HELP-
treatment MAY BE CONSIDERED FUL AND MAY BE HARMFUL
T
C LEVEL A ■ Recommendation that ■ Recommendation in favor ■ Recommendation’s ■ Recommendation that
E
FF Multiple (3-5) population procedure or treatment of treatment or procedure usefulness/efficacy less procedure or treatment is
T E risk strata evaluated* is useful/effective being useful/effective well established not useful/effective and
EN General consistency of ■ Sufficient evidence from ■ Some conflicting evidence ■ Greater conflicting may be harmful
TM direction and magnitude multiple randomized trials from multiple randomized evidence from multiple ■ Sufficient evidence from
EA of effect or meta-analyses trials or meta-analyses randomized trials or multiple randomized trials
R meta-analyses or meta-analyses
T
F
ON) O LLiEmViEteLd B(2-3) population p■r oRceecdoumrem oern dtraetaiotmn ethnat t o■f Rtreecaotmmemnet nodra ptiroonc eind ufarev or u■s Refeuclonmesms/eenffidcaaticoyn ’lse s s p■r oRceecdoumrem oern dtraetaiotmn ethnat ti s
SI risk strata evaluated* is useful/effective being useful/effective well established not useful/effective and
CI ■ Limited evidence from ■ Some conflicting evidence ■ Greater conflicting may be harmful
E
R single randomized trial or from single randomized trial evidence from single ■ Limited evidence from
P
Y ( nonrandomized studies or nonrandomized studies randomized trial or single randomized trial or
T nonrandomized studies nonrandomized studies
N
AI
RT LEVEL C ■ Recommendation that ■ Recommendation in favor ■ Recommendation’s ■ Recommendation that
CE Very limited (1-2) procedure or treatment is of treatment or procedure usefulness/efficacy less procedure or treatment is
OF population risk strata useful/effective being useful/effective well established not useful/effective and
E evaluated* ■ Only expert opinion, case ■ Only diverging expert ■ Only diverging expert may be harmful
T
A studies, or standard-of-care opinion, case studies, opinion, case studies, or ■ Only expert opinion, case
M
TI or standard-of-care standard-of-care studies, or standard-of-care
S
E

6