2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

Priori, Silvia G.; Blomström‐Lundqvist, Carina; Mazzanti, Andrea; Blom, Nico A.; Borggrefe, Martin; Camm, John; Elliott, Perry; Fitzsimons, Donna; Hatala, Róbert; Hindricks, Gerhard; Kirchhof, Paulus; Kjeldsen, Keld; Kück, Karl‐Heinz; Hernández‐Madrid, Antonio; Νικολάου, Νικόλαος; Norekvål, Tone M.; Spaulding, Christian; Veldhuisen, Dirk J. van

doi:10.1093/europace/euv319

Cited by 369 publications

(159 citation statements)

References 794 publications

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“…Although catheter ablation is the current state-of-the-art treatment for drug-refractory ventricular arrhythmias in patients with structural heart disease, 12 it is not curative for many patients. 13-22 Common reasons for catheter-ablation failures include inaccessible arrhythmogenic tissue and an inability to deliver adequate ablative energy transmurally across ventricular myocardium.…”

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confidence: 99%

Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia

Schill²,

et al. 2017

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BACKGROUND Recent advances have enabled noninvasive mapping of cardiac arrhythmias with electrocardiographic imaging and noninvasive delivery of precise ablative radiation with stereotactic body radiation therapy (SBRT). We combined these techniques to perform catheter-free, electrophysiology-guided, noninvasive cardiac radioablation for ventricular tachycardia. METHODS We targeted arrhythmogenic scar regions by combining anatomical imaging with noninvasive electrocardiographic imaging during ventricular tachycardia that was induced by means of an implantable cardioverter–defibrillator (ICD). SBRT simulation, planning, and treatments were performed with the use of standard techniques. Patients were treated with a single fraction of 25 Gy while awake. Efficacy was assessed by counting episodes of ventricular tachycardia, as recorded by ICDs. Safety was assessed by means of serial cardiac and thoracic imaging. RESULTS From April through November 2015, five patients with high-risk, refractory ventricular tachycardia underwent treatment. The mean noninvasive ablation time was 14 minutes (range, 11 to 18). During the 3 months before treatment, the patients had a combined history of 6577 episodes of ventricular tachycardia. During a 6-week postablation “blanking period” (when arrhythmias may occur owing to postablation inflammation), there were 680 episodes of ventricular tachycardia. After the 6-week blanking period, there were 4 episodes of ventricular tachycardia over the next 46 patient-months, for a reduction from baseline of 99.9%. A reduction in episodes of ventricular tachycardia occurred in all five patients. The mean left ventricular ejection fraction did not decrease with treatment. At 3 months, adjacent lung showed opacities consistent with mild inflammatory changes, which had resolved by 1 year. CONCLUSIONS In five patients with refractory ventricular tachycardia, noninvasive treatment with electrophysiology-guided cardiac radioablation markedly reduced the burden of ventricular tachycardia. (Funded by Barnes–Jewish Hospital Foundation and others.)

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confidence: 99%

Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia

Schill²,

et al. 2017

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“…The invasive nature of the ICD implantation procedure, the potential complications related to an intravascular system, and the hypothesis that cardiac function will be resumed could make the S‐ICD a new prophylactic strategy for patients who are at significant risk of VT/VF and do not have a definite course from temporary‐to‐permanent ICD indication. Current ESC guidelines suggest that patients on the waiting list for heart transplantation or ICD implantation, those with peripartum cardiomyopathy, active myocarditis, or severe early postinfarction arrhythmias should be potential candidates for a wearable cardioverter–defibrillator (WCD) 3. Similarly, a temporary ICD should be advised when the definitive indication for an ICD is not yet established or when ICD implantation needs to be deferred in patients with surgical contraindication (e.g., infection, vascular obstruction, treatable comorbidities) 3.…”

Section: Case Reportmentioning

confidence: 99%

“…Current ESC guidelines suggest that patients on the waiting list for heart transplantation or ICD implantation, those with peripartum cardiomyopathy, active myocarditis, or severe early postinfarction arrhythmias should be potential candidates for a wearable cardioverter–defibrillator (WCD) 3. Similarly, a temporary ICD should be advised when the definitive indication for an ICD is not yet established or when ICD implantation needs to be deferred in patients with surgical contraindication (e.g., infection, vascular obstruction, treatable comorbidities) 3.…”

Section: Case Reportmentioning

confidence: 99%

“…The S‐ICD is now an established alternative to a transvenous defibrillator for the prevention of SCD, particularly when access to the heart via the vascular system is difficult, in young patients with a long‐term need for ICD therapy and after device‐related infections 3, 5, 6. The less invasiveness of the S‐ICD ensures easy removal of the entire system with a reduced risk in extracting this device, compared to an intravascular ICD, even in the case of concomitant trauma or infection.…”

Section: Case Reportmentioning

confidence: 99%

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Subcutaneous defibrillator implantation as a bridge until left ventricular function normalizes

Bisignani

Bonis

Pasquale

et al. 2017

Clinical Case Reports

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Key Clinical MessagePatients with reversible cardiac impairment may be, at least temporarily, at high risk of SCD and may go unprotected for considerable time. A less‐invasive definitive or bridge solution is the implantation of a subcutaneous cardioverter–defibrillator (S‐ICD). The less invasiveness of this procedure ensures easy removal of the system without exposing the patient to the risk of complications.

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“…Antiarrhythmic drugs, which would seem a logical means of reducing SCD due to ventricular arrhythmias, have not been shown convincingly to prevent SCD in patients with ventricular arrhythmias. However, they can improve overall mortality [16] and hence are recommended as adjunctive therapy in very selected circumstances [17].…”

Section: Introductionmentioning

confidence: 99%

Primary Prevention of Sudden Cardiac Death in Patients with Heart Failure: How Effective is Current Pharmacologic Therapy?

Gavira¹,

García‐Bolao²,

Dı́ez³

2016

Cardiovasc Pharm Open Access

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Sudden cardiac death is the most common cause of death in the early stages of heart failure. Implantable cardioverter-defibrillator therapies substantially reduce sudden cardiac death but incur morbidity and are expensive, so are recommended only after failure of optimal medical therapy. Guidelines recommend simultaneous first-line therapy with an angiotensin converting enzyme inhibitor and a beta blocker for heart failure with reduced ejection fraction, with diuretic therapy for symptom relief. The all-cause mortality benefit of angiotensin converting enzyme inhibitors (or angiotensin receptor blockers) in this setting is largely attributable to reduced deaths related to disease progression. Addition of a beta blocker improves both all-cause survival and rates of sudden cardiac death. Where symptoms persist, introduction of a mineralocorticoid receptor antagonist is recommended and can reduce sudden cardiac death. If symptoms continue, substitution of the angiotensin converting enzyme inhibitor with the angiotensin receptor neprilysin inhibitor sacubitril/valsartan significantly reduces all-cause mortality, with the benefit arising from fewer deaths from both sudden cardiac death and worsening heart failure. Further medical interventions should be instituted in specific situations as required. Disappointingly, despite evidence-led guidelines, approximately a quarter of patients who have heart failure with reduced ejection fraction do not receive standard therapy with an angiotensin converting enzyme inhibitor and beta blocker. It remains to be seen if recent guidelines for successive interventions in the event of non-response to standard therapy are more effectively adopted.

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2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

Cited by 369 publications

References 794 publications

Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia

Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia

Subcutaneous defibrillator implantation as a bridge until left ventricular function normalizes

Primary Prevention of Sudden Cardiac Death in Patients with Heart Failure: How Effective is Current Pharmacologic Therapy?

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