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Implantable defibrillators in primary prevention of genetic arrhythmias. A shocking choice?( )

Many previously unexplained life-threatening ventricular arrhythmias and sudden cardiac deaths (SCDs) in young individuals are now recognized to be genetic in nature and are ascribed to a growing number of distinct inherited arrhythmogenic diseases. These include hypertrophic cardiomyopathy, arrhyth...

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Autores principales: Corrado, Domenico, Link, Mark S, Schwartz, Peter J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9443985/
https://www.ncbi.nlm.nih.gov/pubmed/35725934
http://dx.doi.org/10.1093/eurheartj/ehac298
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author Corrado, Domenico
Link, Mark S
Schwartz, Peter J
author_facet Corrado, Domenico
Link, Mark S
Schwartz, Peter J
author_sort Corrado, Domenico
collection PubMed
description Many previously unexplained life-threatening ventricular arrhythmias and sudden cardiac deaths (SCDs) in young individuals are now recognized to be genetic in nature and are ascribed to a growing number of distinct inherited arrhythmogenic diseases. These include hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia (VT), and short QT syndrome. Because of their lower frequency compared to coronary disease, risk factors for SCD are not very precise in patients with inherited arrhythmogenic diseases. As randomized studies are generally non-feasible and may even be ethically unjustifiable, especially in the presence of effective therapies, the risk assessment of malignant arrhythmic events such as SCD, cardiac arrest due to ventricular fibrillation (VF), appropriate implantable cardioverter defibrillator (ICD) interventions, or ICD therapy on fast VT/VF to guide ICD implantation is based on observational data and expert consensus. In this document, we review risk factors for SCD and indications for ICD implantation and additional therapies. What emerges is that, allowing for some important differences between cardiomyopathies and channelopathies, there is a growing and disquieting trend to create, and then use, semi-automated systems (risk scores, risk calculators, and, to some extent, even guidelines) which then dictate therapeutic choices. Their common denominator is a tendency to favour ICD implantation, sometime with reason, sometime without it. This contrasts with the time-honoured approach of selecting, among the available therapies, the best option (ICDs included) based on the clinical judgement for the specific patient and after having assessed the protection provided by optimal medical treatment.
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spelling pubmed-94439852022-09-06 Implantable defibrillators in primary prevention of genetic arrhythmias. A shocking choice?( ) Corrado, Domenico Link, Mark S Schwartz, Peter J Eur Heart J State of the Art Review Many previously unexplained life-threatening ventricular arrhythmias and sudden cardiac deaths (SCDs) in young individuals are now recognized to be genetic in nature and are ascribed to a growing number of distinct inherited arrhythmogenic diseases. These include hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia (VT), and short QT syndrome. Because of their lower frequency compared to coronary disease, risk factors for SCD are not very precise in patients with inherited arrhythmogenic diseases. As randomized studies are generally non-feasible and may even be ethically unjustifiable, especially in the presence of effective therapies, the risk assessment of malignant arrhythmic events such as SCD, cardiac arrest due to ventricular fibrillation (VF), appropriate implantable cardioverter defibrillator (ICD) interventions, or ICD therapy on fast VT/VF to guide ICD implantation is based on observational data and expert consensus. In this document, we review risk factors for SCD and indications for ICD implantation and additional therapies. What emerges is that, allowing for some important differences between cardiomyopathies and channelopathies, there is a growing and disquieting trend to create, and then use, semi-automated systems (risk scores, risk calculators, and, to some extent, even guidelines) which then dictate therapeutic choices. Their common denominator is a tendency to favour ICD implantation, sometime with reason, sometime without it. This contrasts with the time-honoured approach of selecting, among the available therapies, the best option (ICDs included) based on the clinical judgement for the specific patient and after having assessed the protection provided by optimal medical treatment. Oxford University Press 2022-06-21 /pmc/articles/PMC9443985/ /pubmed/35725934 http://dx.doi.org/10.1093/eurheartj/ehac298 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle State of the Art Review
Corrado, Domenico
Link, Mark S
Schwartz, Peter J
Implantable defibrillators in primary prevention of genetic arrhythmias. A shocking choice?( )
title Implantable defibrillators in primary prevention of genetic arrhythmias. A shocking choice?( )
title_full Implantable defibrillators in primary prevention of genetic arrhythmias. A shocking choice?( )
title_fullStr Implantable defibrillators in primary prevention of genetic arrhythmias. A shocking choice?( )
title_full_unstemmed Implantable defibrillators in primary prevention of genetic arrhythmias. A shocking choice?( )
title_short Implantable defibrillators in primary prevention of genetic arrhythmias. A shocking choice?( )
title_sort implantable defibrillators in primary prevention of genetic arrhythmias. a shocking choice?( )
topic State of the Art Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9443985/
https://www.ncbi.nlm.nih.gov/pubmed/35725934
http://dx.doi.org/10.1093/eurheartj/ehac298
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