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Dilated Cardiomyopathy
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Marco Merlo, Alessia Paldino, Giulia De Angelis, Gianfranco Sinagra
The risk stratification for SCD in patients with DCM is still an open discussion. Recent studies show that only 31% of patients still meet the criteria for ICD implantation after six months of optimal medical therapy.83 Accordingly, before deciding on an ICD implant, at least three to six months of optimal medical therapy are necessary.24 However, ~2% of patients with DCM die suddenly after diagnosis.78 Thus, how to select early candidates for ICD in primary prevention or for wearable ICD is still an open question. However, LV dilatation, wider QRS complex, and poor tolerance to β-blocker up-titration, more than LVEF, have been identified at baseline as early predictors of SCD and major ventricular arrhythmia in a large population of patients with DCM.78
Arrhythmias in Hypertrophic Cardiomyopathy and Their Management
Published in Srilakshmi M. Adhyapak, V. Rao Parachuri, Hypertrophic Cardiomyopathy, 2020
Tom Kai Ming Wang, Milind Y. Desai
Avoidance of competitive sports is recommended in patients with HCM to prevent SCD [1, 2]. Implantable cardiac defibrillators (ICD) are a type of CIED and one of the cornerstones of HCM management for the effective primary and secondary prevention of SCD, with current guidelines summarized in Table 11.4 [1, 2, 54]. The indication is straightforward in secondary prevention of previously resuscitated cardiac arrest, syncope, or hemodynamic compromise from VT or VF with life expectancy of at least one year. For primary prevention, the risk evaluation is based on factors discussed in previous sections. The American guidelines suggest ICD as reasonable if HCM patients have family history of SCD in a first-degree relative, left ventricular wall thickness of at least 30 mm, or recent unexplained syncope, and may be considered for non-sustained VT or abnormal blood pressure response with exercise [1]. The European guidelines utilize the HCM Risk-SCD calculator based on age, family history of SCD, unexplained syncope, LVOT gradient, left ventricular maximum wall thickness, left atrial diameter, and NSVT [2, 28]. Intracardiac defibrillator is indicated if the five-year calculated risk of SCD is > 6% and can be considered if 4–6%. This should be assessed at baseline, every one to two years, and when there is a change in clinical status.
Heterocyclic Drugs from Plants
Published in Rohit Dutt, Anil K. Sharma, Raj K. Keservani, Vandana Garg, Promising Drug Molecules of Natural Origin, 2020
Debasish Bandyopadhyay, Valeria Garcia, Felipe Gonzalez
The electrophysiological mechanism of actions of amiodarone are not completely understood. However, amiodarone prolongs repolarization by inhibition of outward potassium channels (Auer et al., 2002) and it is usually given to patients with an Implantable Cardioverter Defibrillator, abbreviated as ICD. An ICD is a battery-powered device which is placed under the skin to keep track of the patient’s’ heart rate (Implantable Cardioverter Defibrillator (ICD), 2016). If the device detects abnormal heartbeats, then the device will then deliver an electrical shock that will restore the normal heartbeat. By using amiodarone in ICD patients,’ the shocks which the device gives out are reduced and amiodarone regulates the heartbeat.
Usefulness of insertable cardiac monitors for risk stratification: current indications and clinical evidence
Published in Expert Review of Medical Devices, 2023
Amira Assaf, Dominic AMJ Theuns, Michelle Michels, Jolien Roos-Hesselink, Tamas Szili-Torok, Sing-Chien Yap
In patients with a structural or electrical heart disease, risk stratification for SCD is usually based on a disease-specific multiparametric model [3–10] (Table 1). For many heart diseases, the occurrence of syncope, especially arrhythmogenic syncope, is an important risk factor and may guide the decision to implant an ICD [3,5–7,10,11]. Another important risk factor is the presence of (recurrent) nonsustained ventricular tachycardia (NSVT) which is usually detected during Holter monitoring or exercise testing [3,5,12]. The decision to implant an ICD can be difficult, especially in young patients, considering the potential life-long complications of device therapy including lead failure, device-related infection, inappropriate shocks, need for lead extraction and psychological burden [13–16]. In general, the guidelines recommend (class I) an ICD for patients who experience aborted SCD or sustained ventricular tachycardia (VT) that is not hemodynamically tolerated [17,18].
Ventricular tachycardia ablation as an alternative to implantable cardioverter-defibrillators in patients with preserved ejection fraction: current status and future prospects
Published in Expert Review of Medical Devices, 2022
Philippe Maury, Maxime Beneyto, Pierre Mondoly, Hubert Delasnerie, Anne Rollin
Randomized prospective trials are urgently needed for evaluating the place of first choice VT ablation alone, without ICD implantation. The demonstration of a lack of harmful consequences after catheter ablation only would probably change our practices and guidelines for the future years. Avoiding ICD implantation would be worth regarding health costs, need for device’s follow-up and remote monitoring, and related complications. Provided that the risk for late SD is low enough – and whose rate may be discussed regarding risk acceptance – this would let patients nonimplanted once ablated. The future multicenter prospective randomized trial VIVA (“Ventricular Tachycardia ICD versus Ablation”) will solve this important and still underinvestigated issue. Moreover, it is conceivable that even primary implantation could be replaced by prophylactic ablation in a more far future. Because the underlying cardiac disease can significantly impact prognosis, careful prospective studies are needed for each disease to determine whether ablation alone can outperform ICD.
Cardiac biomarkers for risk stratification of arrhythmic death in patients with heart failure and reduced ejection fraction
Published in British Journal of Biomedical Science, 2021
AL Burger, S Stojkovic, A Diedrich, J Wojta, S Demyanets, T Pezawas
Arrhythmic death or resuscitated cardiac arrest was the primary endpoint, overall mortality was the secondary outcome parameter. An adapted form of the of the Hinkle classification [21] was applied to categorize deaths. Patients with already implanted ICDs: appropriate ICD therapy without ventricular tachycardia acceleration that failed to save the patient’s life during the arrhythmic event was classified as an arrhythmic death. Ventricular fibrillation or ventricular tachycardia >240 bpm (beats per minute) leading to syncope before ICD therapy and multiple slower ventricular tachycardia episodes (electrical storm) leading to syncope and ICD discharge without ICD therapy related acceleration was classified as resuscitated cardiac arrest All other ICD discharges because of ventricular tachycardia <240 bpm were not taken as a surrogate for resuscitated cardiac arrest [8,9,22,23].