HRS/ACC/AHA Expert Consensus Statement on the Use of Implantable Cardioverter-Defibrillator Therapy in Patients Who Are Not Included or Not Well Represented in Clinical Trials

Kusumoto, Fred; Calkins, Hugh; Boehmer, John; Buxton, Alfred E.; Chung, Mina K.; Gold, Michael R.; Hohnloser, Stefan H.; Indik, Julia H.; Lee, Richard; Mehra, Mandeep R.; Menon, Venu; Page, Richard L.; Shen, Win‐Kuang; Slotwiner, David J.; Stevenson, Lynne Warner; Varosy, Paul D.; Welikovitch, Lisa

doi:10.1161/cir.0000000000000056

Cited by 103 publications

(56 citation statements)

References 169 publications

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“…DCM patients with both an arrhythmogenic phenotype and a family history of SCD or ventricular arrhythmias are the highest risk group and should be considered candidates for careful follow‐up and possibly for ICD implantation for primary prevention, regardless of their LVEF or LVEDD 15. In our study, the risk of arrhythmic events was associated with these risk factors and significantly increased when they were combined (see Figure 3).…”

Section: Discussionmentioning

confidence: 62%

“…AR‐DCM phenotype was diagnosed by the presence of 1 of the following: (1) unexplained syncope (likely due to ventricular tachyarrhythmia),2, 14, 15, 16 (2) rapid nonsustained ventricular tachycardia (NSVT) defined as ≥5 consecutive ventricular beats,17 lasting <30 seconds, with a rate ≥150/min on 24‐hour Holter monitoring,18 (3) ≥1000 premature ventricular contractions (PVCs) in 24 hours1 or (4) ≥50 couplets in 24 hours 19. ICD implantation had been performed for primary prevention in selected patients with DCM considered at high risk for SCD (ie, persistent LV dysfunction with LVEF ≤35% and New York Heart Association class II or III while being treated with optimal medical therapy).…”

Section: Methodsmentioning

confidence: 99%

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Arrhythmogenic Phenotype in Dilated Cardiomyopathy: Natural History and Predictors of Life‐Threatening Arrhythmias

Spezzacatene

Sinagra

Merlo

et al. 2015

JAHA

109

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BackgroundPatients with dilated cardiomyopathy (DCM) may present with ventricular arrhythmias early in the disease course, unrelated to the severity of left ventricular dysfunction. These patients may be classified as having an arrhythmogenic DCM (AR‐DCM). We investigated the phenotype and natural history of patients with AR‐DCM.Methods and ResultsTwo hundred eighty‐five patients with a recent diagnosis of DCM (median duration of the disease 1 month, range 0 to 7 months) and who had Holter monitoring at baseline were comprehensively evaluated and followed for 107 months (range 29 to 170 months). AR‐DCM was defined by the presence of ≥1 of the following: unexplained syncope, rapid nonsustained ventricular tachycardia (≥5 beats, ≥150 bpm), ≥1000 premature ventricular contractions/24 hours, and ≥50 ventricular couplets/24 hours, in the absence of overt heart failure. The primary end points were sudden cardiac death (SCD), sustained ventricular tachycardia (SVT), or ventricular fibrillation (VF). The secondary end points were death from congestive heart failure or heart transplantation. Of the 285 patients, 109 (38.2%) met criteria for AR‐DCM phenotype. AR‐DCM subjects had a higher incidence of SCD/SVT/VF compared with non–AR‐DCM patients (30.3% vs 17.6%, P=0.022), with no difference in the secondary end points. A family history of SCD/SVT/VF and the AR‐DCM phenotype were statistically significant and cumulative predictors of SCD/SVT/VF.ConclusionsOne‐third of DCM patients may have an arrhythmogenic phenotype associated with increased risk of arrhythmias during follow‐up. A family history of ventricular arrhythmias in DCM predicts a poor prognosis and increased risk of SCD.

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Section: Discussionmentioning

confidence: 62%

Section: Methodsmentioning

confidence: 99%

Arrhythmogenic Phenotype in Dilated Cardiomyopathy: Natural History and Predictors of Life‐Threatening Arrhythmias

Spezzacatene

Sinagra

Merlo

et al. 2015

JAHA

109

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“…188 There are potential harms with this unproven aggressive practice, and currently, there is insufficient evidence to suggest altering clinical decision making for implantation of cardioverter-defibrillators on the basis of the cause of the ischemic event. 172,189 …”

Section: Early Scad Outcomes: Implications For Duration Of Hospitalizmentioning

confidence: 99%

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

Hayes¹,

Kim²,

Saw³

et al. 2018

Circulation

895

1,344

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Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented.

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“…217 Women with sustained ventricular arrhythmias occurring >48 hours after AMI, in the absence of other reversible causes, should have an ICD placed before hospital discharge for secondary prevention of SCD. [391][392][393][394] Women with reduced ejection fraction after AMI should be reassessed for ICD candidacy for primary prevention of SCD ≥40 days after discharge. [394][395][396] Currently, there are no sex-specific guidelines with respect to ICD use; however, women are less likely to receive an ICD for primary or secondary prevention of SCD compared with men.…”

Section: Arrhythmiasmentioning

confidence: 99%

“…[391][392][393][394] Women with reduced ejection fraction after AMI should be reassessed for ICD candidacy for primary prevention of SCD ≥40 days after discharge. [394][395][396] Currently, there are no sex-specific guidelines with respect to ICD use; however, women are less likely to receive an ICD for primary or secondary prevention of SCD compared with men. 397 Substudies of large, randomized trials have shown lower appropriate ICD shock rates in women compared with men; however, there are variable results in terms of ICD mortality benefit, perhaps a result of the low number of women in these post hoc substudies.…”

Section: Arrhythmiasmentioning

confidence: 99%

Acute Myocardial Infarction in Women

Mehta¹,

Beckie²,

DeVon³

et al. 2016

Circulation

906

393

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Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease. This is the first scientific statement from the American Heart Association on acute myocardial infarction in women. Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. This statement provides a comprehensive review of the current evidence of the clinical presentation, pathophysiology, treatment, and outcomes of women with acute myocardial infarction.

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HRS/ACC/AHA Expert Consensus Statement on the Use of Implantable Cardioverter-Defibrillator Therapy in Patients Who Are Not Included or Not Well Represented in Clinical Trials

Cited by 103 publications

References 169 publications

Arrhythmogenic Phenotype in Dilated Cardiomyopathy: Natural History and Predictors of Life‐Threatening Arrhythmias

Arrhythmogenic Phenotype in Dilated Cardiomyopathy: Natural History and Predictors of Life‐Threatening Arrhythmias

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

Acute Myocardial Infarction in Women

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