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Sudden Cardiac Defibrillation



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Implantable Defibrillator - 02) Facts about Sudden Cardiac Arrest

The COPE line is not for medical emergencies — if you need medical help, please call your medical provider or Sudden Cardiac Arrest is a leading cause of death in the United States, out-of-hospital cardiac arrests claim more than , lives each year. During a sudden cardiac arrest, heart function ceases — abruptly and without warning. When this occurs, the heart is no longer able to pump blood to the rest of the body. SCA is not a heart attack. A heart attack occurs when a blood vessel becomes blocked and interrupts blood flow to the heart, causing heart muscle to die. Most of these deaths occur with little or no warning, from a syndrome called sudden cardiac arrest. The most common cause of sudden cardiac arrest is a disturbance in the heart rhythm called ventricular fibrillation.

Help us in our mission to save lives from sudden cardiac arrest. We focus on driving collaboration and increasing awareness of sudden cardiac arrest; eliminating preventable deaths through education, awareness, and improved public access to defibrillation; promoting immediate bystander action, and fostering survivor recovery. To donate, please click the button or paste the url squareup. All rights Reserved. Design by Elementor. The Data Tells A Story. An ICD uses electric pulses or shocks to help control dangerous arrhythmias. You may be able to lower your risk of SCA by following a heart-healthy lifestyle. If you have coronary artery disease or another heart disease, treating that disease can also lower your risk of SCA.

The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health. Learn More Related Issues. See, Play and Learn No links available. Research Clinical Trials Journal Articles. Resources Reference Desk Find an Expert. For You Teenagers Patient Handouts. What is sudden cardiac arrest SCA? How is sudden cardiac arrest SCA different from a heart attack? Sometimes an SCA can happen after or during recovery from a heart attack.

What causes sudden cardiac arrest SCA? Certain diseases and conditions can cause the electrical problems that lead to SCA. They include Ventricular fibrillation , a type of arrhythmia where the ventricles the heart's lower chambers don't beat normally. Instead, they beat very fast and very irregularly. They can't pump blood to the body. This causes most SCAs. Coronary artery disease CAD , also called ischemic heart disease. CAD happens when the arteries of the heart cannot deliver enough oxygen-rich blood to the heart. It is often caused by the buildup of plaque , a waxy substance, inside the lining of larger coronary arteries.

The plaque blocks some or all of the blood flow to the heart. Some types of physical stress can cause your heart's electrical system to fail, such as Intense physical activity in which your body releases the hormone adrenaline. This hormone can trigger SCA in people who have heart problems. Very low blood levels of potassium or magnesium. These minerals play an important role in your heart's electrical system.

Major blood loss Severe lack of oxygen Certain inherited disorders which can cause arrhythmias or problems with the structure of your heart Structural changes in the heart , such as an enlarged heart due to high blood pressure or advanced heart disease. Heart infections can also cause changes to the structure of the heart. Who is at risk for sudden cardiac arrest SCA? But CAD usually doesn't cause symptoms, so they may not know that they have it. In patients with recurrent VT or VF despite complete revascularization and optimal medical treatment, radiofrequency catheter ablation should be considered. In almost all cases the substrate can be accessed from the endocardium. Precise catheter mapping and successful ablation of triggers for VT or VF, or myocardial substrate sustaining VT or VF, is a complex and demanding procedure.

Thus early referral of patients presenting with VT or VF storms to specialized ablation centres should be considered. In selected cases with recurrent VT or VF that cannot be managed with the treatment recommendations given above, implantation of LV assist devices or extracorporeal life support should be considered for haemodynamic stabilization. Such interventions may also generate time windows allowing coronary interventions in cardiogenic shock due to recurrent VT or VF. Although haemodynamic stabilization can be achieved with ventricular assist devices, the likelihood of VT or VF recurrence is high and interventional treatment is difficult.

Bradycardia and heart block can occur and are associated with increased hospital mortality. AV block is most often due to proximal occlusion of the right coronary artery or a dominant circumflex artery. Prompt coronary revascularization most often resolves conduction. Early VF i. Not all of the later deaths are sudden, and the decision for defibrillator therapy needs to be based on the presence of additional risk factors in addition to VF or VT in the setting of ACS. Risk stratification for sudden cardiac death early within 10 days after myocardial infarction.

SCD is an important cause of death after acute myocardial infarction and is often due to recurrent infarction. Nonetheless, early defibrillator implantation after an infarction does not improve prognosis, probably due to competing causes of death. While several non-invasive risk markers for sudden death have been tested and abandoned in this cohort, some data support the use of an early programmed stimulation in acute myocardial infarction survivors with a reduced LVEF, as those without inducible monomorphic VT have a low risk of subsequent sudden death. Timing of implantable cardioverter defibrillator placement after myocardial infarction.

Assessment of left ventricular ejection fraction. The type of VA must be assessed monomorphic, polymorphic, pleomorphic VT or VF as well as the VT cycle length non-sustained short runs or non-sustained long runs. If programmed stimulation was performed, inducibility and the type of induced arrhythmia monomorphic VT, polymorphic VT, VF should be assessed. LVEF should be assessed 6—12 weeks after myocardial infarction in stable patients and in those on optimized HF medication to assess a potential indication for a primary preventive defibrillator implantation. This evaluation should be structured and offered to all patients. Modern revascularization and secondary prevention therapy allows preservation of LVEF in most patients presenting early with an acute myocardial infarction.

Improved SCD risk-detection strategies in the intermediate-risk population are needed. Risk stratification in patients with stable coronary artery disease after myocardial infarction with preserved ejection fraction. To date, in patients with remote myocardial infarction and preserved LVEF, no non-invasive risk stratification technique has demonstrated sufficient specificity and sensitivity. Revascularization in patients with stable coronary artery disease after myocardial infarction with preserved ejection fraction.

Guidelines for coronary revascularization have been published recently. Surgical revascularization may increase survival and prevent SCD. Implantation of an epicardial ICD lead at the time of coronary artery bypass grafting is not associated with an overall mortality benefit. Percutaneous coronary intervention is also associated with a marked decline in cardiac mortality driven by fewer deaths from myocardial infarction or sudden death. This is particularly true for those with evidence of ischaemic or hibernating myocardium on preoperative imaging studies. In patients who survive SCD, revascularization can reduce the recurrence of life-threatening arrhythmias and SCD and also improve patient outcomes, particularly if there is evidence of ischaemia preceding SCD.

Sustained monomorphic VT in patients with previous myocardial infarction is less likely to be affected by revascularization. Myocardial revascularization is unlikely to prevent recurrent SCD in patients with extensive myocardial scarring and markedly depressed LVEF. The role of anti-arrhythmic drugs in the prevention of SCD in post-myocardial infarction patients with preserved ejection fraction is limited. Most of the data come from the CAST study, which showed that sodium channel blockers class IA and IC agents increase mortality after myocardial infarction.

Class II drugs beta-blockers have an established role in reducing mortality in post-myocardial infarction patients with reduced LVEF and this protective role may also persist in patients with preserved LVEF, but their effect on SCD is unproven. However, it may have a role in the relief of symptoms and the reduction of arrhythmic episodes in this group of patients. For symptomatic but not life-threatening arrhythmias PVCs or short and slow NSVT , amiodarone is the drug of choice since it suppresses arrhythmias without worsening prognosis.

Recurrent VT can be treated effectively with catheter ablation, which dramatically reduces VT recurrence in small patient series treated in specialized centres. Until then, ICD implantation should be considered in survivors of a myocardial infarction suffering from sustained VT or VF in the absence of acute ischaemia, even after successful catheter ablation.

VAs are present in most patients with HF, and sudden death is common in this population. MRAs reduce mortality and reduce rates of sudden death in patients with HF who are already receiving ACE inhibitors and beta-blocker therapy. Angiotensin receptor blockers and ivabradine are only recommended in subgroups of patients with HF. However, in cases of symptomatic ventricular tachy- arrhythmias in patients with HF e. In the past 10 years there has been increased awareness that many patients who have signs and symptoms of HF have a normal or preserved ejection fraction HFpEF.

A relatively high proportion of these patients have non-cardiovascular co-morbidities, and although sudden death is common, there have been no well-powered studies with ICDs or CRT. Most large-scale drug trials in HF were conducted before the positive results from landmark trials with ICDs 63,64 and CRT , became available in ; the evidence from these trials led to a powerful recommendation in the HF guidelines and an enormous increase in their use. Implantable cardioverter defibrillator in patients with left ventricular dysfunction.

Early studies regarding the value of ICDs in LV dysfunction were conducted in patients with a previous cardiac arrest i. While there are more data to support the use of ICDs in survivors of a myocardial infarction i. In the same trial also for patients with ischaemic aetiology, there was only a trend in the reduction of all-cause death [HR 0. Implantable cardioverter defibrillators in patients with New York Heart Association class IV listed for heart transplantation. It is generally accepted that ICD therapy is not recommended in patients with severe, drug-refractory symptoms who are not candidates for CRT, a ventricular assist device or heart transplantation.

These patients often have to wait at least 1 year and their risk of sudden death is high. Data from two observational studies that together examined almost patients, one of them recent and the other older in which the use of beta-blockers was low , have suggested a survival benefit in patients with an ICD. Table A. Table B. For patients in sinus rhythm, recommendations are provided in relation to LBBB vs. For patients with AF, recommendations are provided in Table B in this section. Several other studies, registries and a meta-analysis have addressed the issue of the response to CRT based on QRS morphology and the majority supported the view that QRS morphology with LBBB identifies a subgroup of patients with increased benefit; a short outline of key studies, registries, and meta-analysis is reported here.

This observation is supported by the results of the meta-analysis by Cleland et al. Nery et al. Sipahi et al. Based on a meta-analysis by Sipahi et al. However, methodological concerns due to the multiplicity of analysis in the study by Sipahi et al. Success of CRT in patients with AF is, for the most part, determined by the degree of biventricular pacing, and this can be achieved only by means of AV junction ablation in many patients.

Although the decision to perform AV junction ablation in these patients is still a matter of some debate, recent data suggest that long-term survival after CRT among patients with AF who have undergone AV junction ablation is similar to that observed in patients in sinus rhythm. Table C. Cardiac resynchronization therapy defibrillator a in the primary prevention of sudden death in patients in sinus rhythm with mild New York Heart Association class II heart failure. Treatment of patients with left ventricular dysfunction and premature ventricular complex.

Treatment of patients with left ventricular dysfunction and sustained recurrent monomorphic ventricular tachycardia. However, drug discontinuation was more frequent in patients taking sotalol or a combination of amiodarone and a beta-blocker. The rates of study drug discontinuation at 1 year were Prevention of ventricular tachycardia recurrences in patients with left ventricular dysfunction and sustained ventricular tachycardia. Depending on the underlying substrate, catheter ablation for sustained VT may result in acute termination and reduction of recurrent VT episodes in patients with structural heart disease. In patients with LV dysfunction and sustained VT, scar-mediated re-entry is the common pathophysiological mechanism and ablation targets the critical isthmus within the re-entry circuit.

VT is mostly monomorphic. Irrigated ablation catheters are commonly used, which facilitate deeper lesion formation and reduce the risk of char formation during energy delivery. At present, the best ablative strategy is unknown. In addition, there is no consensus with respect to the ideal procedural endpoint. While elimination of all clinical VTs should be attempted, non-inducibility of any VT after ablation may be the preferred procedural endpoint. Patients may present with electrical storms. Catheter ablation can acutely terminate this potentially life-threating event and has been shown to decrease the rate of recurrent electrical storm episodes when compared with medical treatment only.

Five prospective studies have evaluated the role of catheter ablation in the treatment of sustained VT. The control arm underwent ICD implantation only. None of the patients received anti-arrhythmic drugs. Catheter ablation was performed using a substrate-guided approach targeting abnormal ventricular potentials during sinus rhythm without the need for VT induction. The mean number of appropriate ICD shocks per patient per year decreased from 3. Catheter ablation did not affect mortality. Overall, the success rate of catheter ablation for VT is determined by the amount of infarct-related scar burden, represented as low-voltage areas on electro-anatomic mapping systems, while dedicated units for the treatment of patients undergoing catheter ablation of VT may positively impact outcome.

Prevention of ventricular tachycardia recurrences in patients with bundle branch re-entrant tachycardia. Bundle branch tachycardia is a rare macro-re-entry tachycardia that typically involves the right bundle branch as the anterograde and the left bundle branch as the retrograde limb. Bundle branch re-entry is often associated with cardiomyopathy. Implantation of an ICD in patients with sustained VT increases survival compared with anti-arrhythmic drug therapy.

Cardiomyopathies are myocardial disorders defined by structural and functional abnormalities of the ventricular myocardium that are not solely explained by flow-limiting coronary artery stenosis or abnormal loading conditions. Nearly all cardiomyopathies can be associated with VA and an increased risk of SCD that varies with the aetiology and the severity of the disease. DCM is defined as LV dilatation and systolic dysfunction in the absence of abnormal loading conditions or CAD sufficient to cause global systolic impairment. DCM presents in people of all ages and ethnicities. In adults, it is more common in men than in women, with an overall prevalence of 1 in individuals and a conservative estimated annual incidence of 7 per A large spectrum of acquired conditions can cause DCM, including inflammatory, infective and systemic diseases, as well as various drugs and toxins.

In some cases, patients are genetically predisposed to the development of DCM following exposure to exogenous triggers such as infection, cytotoxic drugs, alcohol and pregnancy. All-cause mortality in unselected adult patients with DCM has decreased substantially with the use of neurohormonal antagonists and device therapy. Many non-invasive variables have been suggested as predictors of sudden death, but in a recent meta-analysis of 45 studies enrolling patients, functional and electrocardiographic variables provided only modest discrimination between high- and low-risk patients. The incremental value of late gadolinium enhancement over other prognostic markers needs to be determined. Follow-up was relatively short in some studies and, as in other settings, the relation of appropriate shocks to prognosis is still uncertain.

In the CASH study, patients were initially randomized to receive an ICD or one of three drugs: amiodarone, metoprolol or propafenone, but the propafenone arm was terminated early due to increased mortality. The final analysis pooled data from the amiodarone and metoprolol arms. The three trials enrolled a total of patients, of whom only Few studies have examined prognosis or treatment in specific DCM subtypes. In previously stable patients with new-onset VA, coronary angiography should be considered in patients with an intermediate to high risk of CAD.

Amiodarone should be considered in patients with an ICD that experience recurrent appropriate shocks in spite of optimal device programming, but should not be used to treat asymptomatic episodes of NSVT. The use of sodium channel blockers and dronedarone is not recommended in patients with impaired LV function because of their potential pro-arrhythmic effects. Studies evaluating different ablation strategies in DCM report, at best, modest success that is not improved when epicardial and endocardial mapping is performed.

In a recent registry study comparing 63 patients with non-ischaemic cardiomyopathy and with ischaemic LV dysfunction, ablation of the clinical VT only was achieved in Prevention of sudden cardiac death in patients with hypertrophic cardiomyopathy. The presence of CAD should be excluded in patients with prolonged or symptomatic episodes if risk factors for coronary atherosclerosis are present. Historically the risk of SCD in patients with HCM has been estimated using a simple score based on a number of selected clinical parameters. Anderson—Fabry disease and syndromes e. Noonan syndrome.

The model does not use exercise-induced LVOT gradients and has not been validated before and after myectomy or alcohol septal ablation. In individual patients with a single risk factor, ICD implantation may be considered after careful consideration of the risks and benefits to the child. Single-chamber defibrillators suffice in the majority of cases and reduce the likelihood of complications. Patients with HCM should be advised against participation in competitive sports and discouraged from intense physical activity, especially when they have recognized risk factors for SCD or an LVOT gradient.

While there are no trials of ICD therapy in HCM, observational cohort studies and meta-analyses show that aborted cardiac arrest or sustained VT are associated with a high risk of subsequent lethal cardiac arrhythmias. In most cases ARVC is inherited as an autosomal dominant genetic trait caused by mutations in genes encoding for desmosomal proteins plakoglobin , desmoplakin, plakophilin-2, desmoglein-2 and desmocollin A minority of cases are caused by mutations in non-desmosomal genes and rare recessive forms e.

Carvajal syndrome and Naxos disease associated with a cutaneous phenotype of palmar and plantar hyperkeratosis. ARVC has an estimated prevalence of 1 in to 1 in of the general population and is an important cause of SCD in athletes and young adults. Disease progression may result in right or biventricular HF. The annual mortality rate reported in different studies varies considerably, depending on the characteristics of reported cohorts. Data from one meta-analysis reported an annualized rate for cardiac mortality, non-cardiac mortality and heart transplantation of 0.

Risk stratification and management of patients with arrhythmogenic right ventricular cardiomyopathy. In a recent prospective registry of patients predominantly treated with an ICD, most appropriate therapies were for sustained monomorphic VT. Few systematic data are available on the efficacy of anti-arrhythmic drugs in ARVC and the impact of medical therapy on mortality is unknown. Based largely on serial PVS testing, beta-blockers—in particular sotalol—are conventionally recommended as the first approach in patients with frequent ventricular ectopy or NSVA.

Invasive electrophysiological testing with voltage mapping can be used to identify regions of fibro-fatty replacement and to guide catheter ablation of VA. As neither anti-arrhythmic drugs nor catheter ablation provides sufficient protection against SCD, ablation should be used to reduce the frequency of arrhythmia episodes rather than to improve prognosis. Endurance training at a competitive level probably exacerbates the phenotype of ARVC. Most studies on risk stratification and ICD therapy are retrospective and of selected and relatively small high-risk cohorts recruited from single centres. Many also provide little information on the indication for an ICD. In a recent systematic review 24 studies and meta-analysis 18 studies of patients followed for a mean period of 3.

Difficult ICD lead placement was reported in The annual rate of inappropriate ICD intervention was 3. Based on available data, the consensus is that patients with unexplained syncope should be considered for an ICD. For patients without syncope, an ICD may be considered following detailed clinical assessment that takes into account family history, severity of RV and LV function, lifelong risk of complications and impact of an ICD on lifestyle, socioeconomic status and psychological health.

The two main types of cardiac amyloidosis are light-chain amyloidosis, caused by deposition of monoclonal light chains, and hereditary transthyretin-associated amyloidosis, in which normal wild-type or mutant transthyretin is deposited in the myocardium. Up to half of all patients with cardiac amyloidosis die suddenly. Elevated levels of cardiac troponins and N-terminal pro-B-type natriuretic peptide are sensitive markers of cardiac involvement and predict adverse outcome in patients with light-chain amyloidosis, but there are no data to suggest that these biomarkers can be used to identify patients who might benefit from an ICD.

There are insufficient data to provide recommendations on primary prophylaxis. Restrictive cardiomyopathy is the least common of all the cardiomyopathies and is caused by a number of genetic and acquired disorders. Patients with restrictive cardiomyopathy typically present with signs and symptoms of biventricular HF and are diagnosed by characteristic features on non-invasive cardiac imaging and cardiac catheterization.

Restrictive cardiomyopathy is associated with poor long-term prognosis. There are fewer data in adults, but reported survival rates are similar at 5 years. Risk factors for all-cause death include NYHA functional class, left atrial size and male sex. The treatment of restrictive cardiomyopathy is mostly palliative. HF symptoms are treated with diuretics and heart rate control to optimize LV filling.

Anticoagulation should be used in all patients with AF. There are no prospective data on prophylactic implantation of ICDs in restrictive cardiomyopathy, so for patients with symptomatic sustained VA, indications for ICD should be similar to those for other heart muscle disease, taking into account the short-term prognosis related to HF. Primary prophylaxis should be determined by the underlying aetiology and the presence of established risk factors for SCD. LV non-compaction occurs in association with congenital cardiac disorders and in an isolated form.

Numerous mutations in genes encoding sarcomere proteins, calcium-handling proteins and other cardiomyopathy-related genes such as LMNA , LDB3 and Taffazin are reported. Increased age, LV end diastolic diameter at presentation, symptomatic HF, permanent or persistent AF, bundle branch block and associated neuromuscular disease are reported predictors for increased mortality, but there are few data to suggest that LV non-compaction by itself is an indication for an ICD. Chagas disease is a myocardial disease caused by the parasite Trypanosoma cruzi. Conduction system abnormalities, including RBBB and left anterior fascicular block, are often the earliest manifestations, followed by segmental LV wall-motion abnormalities, complex VA, sinus node dysfunction and more advanced conduction abnormalities.

In the later stages of the disease there is progressive LV dilatation and systolic dysfunction. Reported annual mortality rates for patients with Chagas disease vary from 0. Primarily thanks to the study by Gali et al. The mean age at presentation is 14 years. Mutations in 13 genes have been associated with LQTS, most encoding for subunits of potassium, sodium or calcium voltage-dependent ion channels. Clinical, electrocardiographic and genetic parameters should be considered for the stratification of individual risk.

However, these findings require further study before application in clinical practice. SQTS is characterized by a reduced duration of cardiac repolarization, which constitutes the substrate for the development of life-threatening arrhythmias. The optimal strategy for primary prevention of cardiac arrest in SQTS is unclear, given the lack of independent risk factors for cardiac arrest, including syncope.

An ICD might be considered on a case-by-case basis in patients with SQTS with a strong family history of SCD and evidence for abbreviated QTc in at least some of the patients, but there are not enough data to make generalized recommendations. Reports on small cohorts of patients suggest that quinidine therapy can prolong the QTc interval and possibly reduce arrhythmic events. Patients on quinidine should be carefully monitored for QT prolongation and possible pro-arrhythmic events. So far there are no data supporting the role of PVS for predicting arrhythmic events. The prevalence of Brugada syndrome seems to be higher in Southeast Asia than in western countries; the prevalence ranges from 1 in to 1 in 10 Brugada syndrome is inherited as a dominant trait and shows age- and sex-related penetrance: clinical manifestations of the disease are more frequent in adults and they are eightfold more frequent in men than in women.

In a recent meta-analysis, the incidence of arrhythmic events sustained VT or VF or appropriate ICD therapy or sudden death in patients with Brugada syndrome was Recently it has been suggested that epicardial catheter ablation over the anterior RVOT may prevent electrical storms in patients with recurring episodes, but the data require confirmation before entering general clinical practice. CPVT is a rare inheritable arrhythmogenic disorder characterized by adrenergic-induced bidirectional and polymorphic VT.

The disease has an estimated prevalence of 1 in 10 Two genetic types of CPVT have been identified: a dominant variant due to mutations in the gene encoding for the cardiac ryanodine receptor gene RyR2 and a rare recessive variant caused by mutation in the cardiac calsequestrin gene CASQ2. However, at the present time it is not clear whether they are phenocopies of CPVT.

The clinical manifestations of CPVT usually occur in the first decade of life and are prompted by physical activity or emotional stress. Risk stratification and management in Catecholaminergic Polymorphic Ventricular Tachycardia. Diagnosis in childhood, the lack of beta-blocker therapy and the persistence of complex arrhythmias during the exercise stress test on a full dose of beta-blockers are independent predictors for arrhythmic events. Most referral centres treat patients with nadolol, even though comparative data on different types of beta-blockers are not available.

Exercise restriction and beta-blockers without intrinsic sympathomimetic activity are the first-line therapy for patients with CPVT. Preliminary data suggest that flecainide significantly reduces the VA burden in a limited number of patients with CPVT and should be considered as the first addition to beta-blockers when control of arrhythmias is incomplete. The genetics of early repolarization are probable polygenic in many instances. No clear evidence of familial transmission of the early repolarization syndrome exists. Given the uncertainties in the interpretation of the early repolarization pattern as a predictor of SCD, this panel of experts has decided that there is insufficient evidence to make recommendations for management of this condition at this time.

Management of ventricular arrhythmias in children with a structurally normal heart. In children, VAs may occur in congenital heart diseases CHDs , inheritable channelopathies or cardiomyopathies, myocarditis and cardiac tumours neonatal rhabdomyomas , as well as in structurally normal hearts. Follow-up is recommended to identify the development of LV dysfunction, non- sustained VT or cardiomyopathies, which seldom occur. Medical treatment or catheter ablation is rarely indicated since most children remain asymptomatic and PVCs often resolve in time. It is a benign arrhythmia and, similar to PVCs in infants, generally disappears without treatment in the first year of life.

The prevalence of non-sustained and sustained VT is also low, at 2—8 per schoolchildren. Verapamil-sensitive left fascicular VT is less common. These tachycardias often lead to HF and have significant mortality despite aggressive drug therapy, catheter ablation and even surgical therapy. In older children, recommendations regarding treatment of idiopathic VTs are similar to those for adults. In young children, studies on the efficacy and safety of drug treatment of idiopathic VTs are limited mainly to beta-blockers and verapamil, with less data available on sodium channel blockers class IC and class III drugs.

In young children, complication rates of catheter ablation appear to be higher and there is concern regarding the growth of radiofrequency and cryo-energy lesions in the ventricular myocardium. Prevention of sudden cardiac death and management of ventricular arrhythmias in patients with congenital heart disease. CHD is the most common birth defect, with an incidence of — per live births. The majority of patients with CHD will live to adulthood. Thus far, no RCTs have been performed to delineate risk factors for SCD or the benefit of primary prevention therapies.

SCD occurred mostly at rest and was not limited to patients with severe defects. In this study, risk factors for SCD were similar to those in ischaemic cardiomyopathy, including supraventricular tachycardia, systemic or pulmonary ventricular dysfunction and prolonged QRS duration. The congenital heart defects with the highest risk of SCD are tetralogy of Fallot, congenitally corrected transposition of the great arteries, left heart obstructed lesions and univentricular hearts. Currently catheter ablation of atrial tachycardia is an effective therapy and relevant for lowering the risk of SCD in this group of patients. PVS does not seem useful for general risk stratification.

ICDs for secondary prevention appear to be effective, whereas primary prevention ICD therapy for patients with ventricular dysfunction seems less useful, with a shock rate of 0. Adequate repair of congenital aortic stenosis including the bicuspid valves substantially reduces the native risk of SCD, often obviating the need for specific anti-arrhythmic therapy. In patients with univentricular hearts after the Fontan operation, long-term morbidity is characterized by complex atrial tachycardia and the development of HF, progressively increasing with age. In general, ICD therapy in patients with CHD has shifted from secondary to primary prevention in the last two decades.

In general, patients with CHD with syncope or non-sustained VT should undergo haemodynamic and electrophysiological evaluation. Catheter ablation and surgical therapies should be considered as an alternative or in addition to an ICD in patients with recurrent sustained VT after surgical repair of CHD. Most recommendations for cardiac diseases relevant for the paediatric population have a level of evidence of B or C. Lead fractures and insulation breaks, vascular problems, infections and late increases in the defibrillation threshold are more common in the paediatric population than in adults, likely due to their higher activity levels, smaller body size and growth. In older paediatric patients, as in adults, transvenous dual-chamber ICD systems are mostly used.

In younger patients, single-chamber systems are commonly used to avoid venous obstruction, leaving a loop of the ICD lead in the right atrium to allow for growth. In infants and small children, alternative non-transvenous ICD systems seem safe and effective. CRT has become an important adjunct to the treatment of HF in paediatric patients, most commonly when there is an indication for antibradycardia pacing.

Treatment is only warranted if patients are symptomatic. It is worth noting that symptoms may be related to LV dysfunction, considering that idiopathic VT may be a cause of tachycardia-induced cardiomyopathy. When ablation at a site with early ventricular activation does not eliminate the clinical arrhythmia, epicardial mapping may be considered.

Similarly, medical providers are often depicted defibrillating patients Sudden Cardiac Defibrillation a Sudden Cardiac Defibrillation ECG rhythm Sudden Cardiac Defibrillation known Sudden Cardiac Defibrillation asystole. Case Western Reserve University. Newer types of resuscitation electrodes are designed Sudden Cardiac Defibrillation an adhesive pad, which includes either Sudden Cardiac Defibrillation or wet gel. Sudden Cardiac Defibrillation the latest Women And Children In Platos Republic news stories Sudden Cardiac Defibrillation straight to your Sudden Cardiac Defibrillation with our daily newsletter Invalid Email Something went Sudden Cardiac Defibrillation, please try again later.

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