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Management of hemodynamically stable wide QRS complex tachycardia in patients with implantable cardioverter defibrillators
Management of hemodynamically stable, incessant wide QRS complex tachycardia (WCT) in patients who already have an implantable cardioverter defibrillator (ICD) is challenging. First-line treatment is performed by medical staff who have no knowledge on programmed ICD therapy settings and there is alw...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9846131/ https://www.ncbi.nlm.nih.gov/pubmed/36684577 http://dx.doi.org/10.3389/fcvm.2022.1011619 |
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author | Regoli, François D. Cattaneo, Mattia Kola, Florenc Thartori, Albana Bytyci, Hekuran Saccarello, Luca Amoruso, Marco Di Valentino, Marcello Menafoglio, Andrea |
author_facet | Regoli, François D. Cattaneo, Mattia Kola, Florenc Thartori, Albana Bytyci, Hekuran Saccarello, Luca Amoruso, Marco Di Valentino, Marcello Menafoglio, Andrea |
author_sort | Regoli, François D. |
collection | PubMed |
description | Management of hemodynamically stable, incessant wide QRS complex tachycardia (WCT) in patients who already have an implantable cardioverter defibrillator (ICD) is challenging. First-line treatment is performed by medical staff who have no knowledge on programmed ICD therapy settings and there is always some concern for unexpected ICD shock. In these patients, a structured approach is necessary from presentation to therapy. The present review provides a systematic approach in four distinct phases to guide any physician involved in the management of these patients: PHASE I: assessment of hemodynamic status and use of the magnet to temporarily suspend ICD therapies, especially shocks; identification of possible arrhythmia triggers; risk stratification in case of electrical storm (ES). PHASE II: The preparation phase includes reversal of potential arrhythmia “triggers”, mild patient sedation, and patient monitoring for therapy delivery. Based on resource availability and competences, the most adequate therapeutic approach is chosen. This choice depends on whether a device specialist is readily available or not. In the case of ES in a “high-risk” patient an accelerated patient management protocol is advocated, which considers urgent ventricular tachycardia transcatheter ablation with or without mechanical cardiocirculatory support. PHASE III: Therapeutic phase is based on the use of intravenous anti-arrhythmic drugs mostly indicated in this clinical context are presented. Device interrogation is very important in this phase when sustained monomorphic VT diagnosis is confirmed, then ICD ATP algorithms, based on underlying VT cycle length, are proposed. In high-risk patients with intractable ES, intensive patient management considers MCS and transcatheter ablation. PHASE IV: The patient is hospitalized for further diagnostics and management aimed at preventing arrhythmia recurrences. |
format | Online Article Text |
id | pubmed-9846131 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-98461312023-01-19 Management of hemodynamically stable wide QRS complex tachycardia in patients with implantable cardioverter defibrillators Regoli, François D. Cattaneo, Mattia Kola, Florenc Thartori, Albana Bytyci, Hekuran Saccarello, Luca Amoruso, Marco Di Valentino, Marcello Menafoglio, Andrea Front Cardiovasc Med Cardiovascular Medicine Management of hemodynamically stable, incessant wide QRS complex tachycardia (WCT) in patients who already have an implantable cardioverter defibrillator (ICD) is challenging. First-line treatment is performed by medical staff who have no knowledge on programmed ICD therapy settings and there is always some concern for unexpected ICD shock. In these patients, a structured approach is necessary from presentation to therapy. The present review provides a systematic approach in four distinct phases to guide any physician involved in the management of these patients: PHASE I: assessment of hemodynamic status and use of the magnet to temporarily suspend ICD therapies, especially shocks; identification of possible arrhythmia triggers; risk stratification in case of electrical storm (ES). PHASE II: The preparation phase includes reversal of potential arrhythmia “triggers”, mild patient sedation, and patient monitoring for therapy delivery. Based on resource availability and competences, the most adequate therapeutic approach is chosen. This choice depends on whether a device specialist is readily available or not. In the case of ES in a “high-risk” patient an accelerated patient management protocol is advocated, which considers urgent ventricular tachycardia transcatheter ablation with or without mechanical cardiocirculatory support. PHASE III: Therapeutic phase is based on the use of intravenous anti-arrhythmic drugs mostly indicated in this clinical context are presented. Device interrogation is very important in this phase when sustained monomorphic VT diagnosis is confirmed, then ICD ATP algorithms, based on underlying VT cycle length, are proposed. In high-risk patients with intractable ES, intensive patient management considers MCS and transcatheter ablation. PHASE IV: The patient is hospitalized for further diagnostics and management aimed at preventing arrhythmia recurrences. Frontiers Media S.A. 2023-01-04 /pmc/articles/PMC9846131/ /pubmed/36684577 http://dx.doi.org/10.3389/fcvm.2022.1011619 Text en Copyright © 2023 Regoli, Cattaneo, Kola, Thartori, Bytyci, Saccarello, Amoruso, Di Valentino and Menafoglio. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Regoli, François D. Cattaneo, Mattia Kola, Florenc Thartori, Albana Bytyci, Hekuran Saccarello, Luca Amoruso, Marco Di Valentino, Marcello Menafoglio, Andrea Management of hemodynamically stable wide QRS complex tachycardia in patients with implantable cardioverter defibrillators |
title | Management of hemodynamically stable wide QRS complex tachycardia in patients with implantable cardioverter defibrillators |
title_full | Management of hemodynamically stable wide QRS complex tachycardia in patients with implantable cardioverter defibrillators |
title_fullStr | Management of hemodynamically stable wide QRS complex tachycardia in patients with implantable cardioverter defibrillators |
title_full_unstemmed | Management of hemodynamically stable wide QRS complex tachycardia in patients with implantable cardioverter defibrillators |
title_short | Management of hemodynamically stable wide QRS complex tachycardia in patients with implantable cardioverter defibrillators |
title_sort | management of hemodynamically stable wide qrs complex tachycardia in patients with implantable cardioverter defibrillators |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9846131/ https://www.ncbi.nlm.nih.gov/pubmed/36684577 http://dx.doi.org/10.3389/fcvm.2022.1011619 |
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