CCS VT 2020 Guidelines

Question 1

When should CMR be performed?

Answer 1

Present with VT/VF when the initial evaluation has failed to establish the etiology of the underlying heart disease.

Question 2

AADs for Sustained PMVT?
-Normal QT with ischemia
-Normal QT without ischemia
-Prolonged QTc

Answer 2

-Normal with Ischemia: Amio or Lido

-No Ischemia: Amio

-Prolonged QT: Mg, Pace, BB, Lidocaine if needed

Question 3

Doses of following in VT?
-Lidocaine
-Amiodarone
-Procainamide

Answer 3

-Lidocaine: 100mg push (50mg if < 45kg), subsequent 50mg push

-Amiodarone: 300mg push (150mg if < 45kg) or 150mg push

-Procainamide: 10mg/kg over 20 minutes

Question 4

First line AAD treatment for MMVT? 2nd line (2)?

Answer 4

1st: Procainamide

2nd: Amiodarone, Lidocaine

Question 5

BB choice and dose for VT storm

Answer 5

Propranolol 40 q6h

Question 6

How does indication for VT ablation vary based on MMVT and ICMO

Answer 6

-In ICMO and MMVT -> Ablation first line

-In NICMO and MMVT -> Ablation 2nd line

-PMVT -> no ablation

Question 7

First line AAD for all VT (not in acute phase) (apart from Prolonged QT)

Answer 7

-Sotalol/AAD

-Prolonged: Optimize BB

Question 8

How to dose reduce Sotalol based on renal function? When to not use?

Answer 8

-Once daily dosing if eGFR 40-60

-If eGFR less than 40 then dont use (AHA SVT, CCS AF 2020)

Question 9

What level of NYHA and LVEF can you use Sotalol?

Answer 9

-NYHA 3, LVEF < 20% (Don’t use if LVEF < 40% for Afib)

Question 10

Monitoring when on Sotalol?

Answer 10

-eGFR q6 months

-ECG: QTc monitoring 5-7 days after starting, and then every 6 months

Question 11

When to stop Sotalol based on QTc?

Answer 11

• 500msec

Question 12

What does Amiodarone do to Digoxin? Warfarin?

Answer 12

-Increases both (By 20-30%)

Question 13

Procedural complication rate of VT ablation?

Answer 13

3-6%

Question 14

How to program VT zone for secondary prevention?

Answer 14

10-20 bpm slower than the slowest documented VT

Question 15

Two causes of Bidirectional VT?

Answer 15

-Digoxin Toxicity

-CPVT

Question 16

What 3 populations have the highest porportion of Cardiac Arrests?

Answer 16

-Post MI

-LVEF < 30%

-Post Cardiac Arrest Survivor

Question 17

What are two treatments for VT from coronary spasm ? (2)

Answer 17

-CCB
-Smoking Cessation

Others from Laflamme (BB, Nitrates, Mg supplementation)

Question 18

Three class 1 indications for Primary Prevention ICD in patients with IHD?

Answer 18

-LVEF < 35%, NYHA II/III despite GDMT, 40 days post MI, 90 days post revascularization, LE > 1 year

-LVEF < 30%, NYHA 1, 40 days post MI, 90 days post revasc, LE > 1 year

-LVEF < 40%, NSVT, Inducible VT/VF in EPS, LE > 1 year

Question 19

What NYHA 4 symptoms to place ICD? (3)

Answer 19

-Secondary Prevention

-Candidate for transplant

-Candidate for LVAD

Question 20

When is ICD in LMNA mutation suggested for primary prevention? (4)

Answer 20

2 or more of the following risk factors:

-NSVT
-LVEF < 45%
-Male
-Nonmissense mutation

Question 21

What is first line VT therapy post BB? (2)

Answer 21

-Sotalol
-Amiodarone

Question 22

What medication is recommended in ARVC?

Answer 22

Beta Blocker

Question 23

When is ICD recommended in ARVC for primary prevention? (1)

Answer 23

-RVEF or LVEF < 35%

(Secondary Prevention as well)

Question 24

Two class 1 indications for ICD placement in Sarcoidosis?

Answer 24

LVEF < 35%

Survivors of Cardiac Arrest

Question 25

When can ICD be used in CAV post transplant ?

Answer 25

LV dysfunction, CAV and LE > 1 year

Question 26

Review Neuromuscular disorders associated with Heart Disease

Answer 26

Question 27

When is Beta Blocker recommended in LQT?

Answer 27

> 470 msec

Symptoms

Question 28

When is Left Cardiac Sympathetic denervation recommended in LQTs?

Answer 28

-BB or ICD indicated but refused

-Ongoing VT despite BB therapy

Question 29

When is ICD indicated in LQTs?

Answer 29

-BB indicated but refused

-Secondary prevention

Question 30

Indication for ICD in Brugada?

Answer 30

Spontaneous Type 1 pattern with Sustained VT, CA, or suspicious syncope

Question 31

When is Catheter ablation indicated for PVC CMO?

Answer 31

-Declining LV function with Frequent PVCs (>15%, monomorphic) for who the antiarrhythmic medications are ineffective, not tolerated -> Catheter ablation is useful

Question 32

What congenital lesion is associated with most amount of Ventricular Arrhythmia?

Answer 32

Tetralogy of Fallot

Question 33

What valvular disease is associated with most amount of Ventricular Arrythmia?

Answer 33

Aortic Stenosis

Question 34

When is Subcutaneous ICD recommended?

Answer 34

Patients who meet criteria for ICD who have inadequate vascular access or are at high risk for infection in whom pacing for brady/CRT not anticipated

Question 35

When to implant ICD for cardiac syncope?

Answer 35

LVEF < 35% (Class 1)