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
