CCS VT 2020 Guidelines Flashcards
When should CMR be performed?
Present with VT/VF when the initial evaluation has failed to establish the etiology of the underlying heart disease.
AADs for Sustained PMVT?
-Normal QT with ischemia
-Normal QT without ischemia
-Prolonged QTc
-Normal with Ischemia: Amio or Lido
-No Ischemia: Amio
-Prolonged QT: Mg, Pace, BB, Lidocaine if needed
Doses of following in VT?
-Lidocaine
-Amiodarone
-Procainamide
-Lidocaine: 100mg push (50mg if < 45kg), subsequent 50mg push
-Amiodarone: 300mg push (150mg if < 45kg) or 150mg push
-Procainamide: 10mg/kg over 20 minutes
First line AAD treatment for MMVT? 2nd line (2)?
1st: Procainamide
2nd: Amiodarone, Lidocaine
BB choice and dose for VT storm
Propranolol 40 q6h
How does indication for VT ablation vary based on MMVT and ICMO
-In ICMO and MMVT -> Ablation first line
-In NICMO and MMVT -> Ablation 2nd line
-PMVT -> no ablation
First line AAD for all VT (not in acute phase) (apart from Prolonged QT)
-Sotalol/AAD
-Prolonged: Optimize BB
How to dose reduce Sotalol based on renal function? When to not use?
-Once daily dosing if eGFR 40-60
-If eGFR less than 40 then dont use (AHA SVT, CCS AF 2020)
What level of NYHA and LVEF can you use Sotalol?
-NYHA 3, LVEF < 20% (Don’t use if LVEF < 40% for Afib)
Monitoring when on Sotalol?
-eGFR q6 months
-ECG: QTc monitoring 5-7 days after starting, and then every 6 months
When to stop Sotalol based on QTc?
- 500msec
What does Amiodarone do to Digoxin? Warfarin?
-Increases both (By 20-30%)
Procedural complication rate of VT ablation?
3-6%
How to program VT zone for secondary prevention?
10-20 bpm slower than the slowest documented VT
Two causes of Bidirectional VT?
-Digoxin Toxicity
-CPVT
What 3 populations have the highest porportion of Cardiac Arrests?
-Post MI
-LVEF < 30%
-Post Cardiac Arrest Survivor
What are two treatments for VT from coronary spasm ? (2)
-CCB
-Smoking Cessation
Others from Laflamme (BB, Nitrates, Mg supplementation)
Three class 1 indications for Primary Prevention ICD in patients with IHD?
-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
What NYHA 4 symptoms to place ICD? (3)
-Secondary Prevention
-Candidate for transplant
-Candidate for LVAD
When is ICD in LMNA mutation suggested for primary prevention? (4)
2 or more of the following risk factors:
-NSVT
-LVEF < 45%
-Male
-Nonmissense mutation
What is first line VT therapy post BB? (2)
-Sotalol
-Amiodarone
What medication is recommended in ARVC?
Beta Blocker
When is ICD recommended in ARVC for primary prevention? (1)
-RVEF or LVEF < 35%
(Secondary Prevention as well)
Two class 1 indications for ICD placement in Sarcoidosis?
LVEF < 35%
Survivors of Cardiac Arrest
When can ICD be used in CAV post transplant ?
LV dysfunction, CAV and LE > 1 year
Review Neuromuscular disorders associated with Heart Disease
When is Beta Blocker recommended in LQT?
> 470 msec
Symptoms
When is Left Cardiac Sympathetic denervation recommended in LQTs?
-BB or ICD indicated but refused
-Ongoing VT despite BB therapy
When is ICD indicated in LQTs?
-BB indicated but refused
-Secondary prevention
Indication for ICD in Brugada?
Spontaneous Type 1 pattern with Sustained VT, CA, or suspicious syncope
When is Catheter ablation indicated for PVC CMO?
-Declining LV function with Frequent PVCs (>15%, monomorphic) for who the antiarrhythmic medications are ineffective, not tolerated -> Catheter ablation is useful
What congenital lesion is associated with most amount of Ventricular Arrhythmia?
Tetralogy of Fallot
What valvular disease is associated with most amount of Ventricular Arrythmia?
Aortic Stenosis
When is Subcutaneous ICD recommended?
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
When to implant ICD for cardiac syncope?
LVEF < 35% (Class 1)
