Updated guidelines released on ventricular arrhythmias and sudden cardiac death

The ACC, AHA, ESC guidelines combine previously published recommendations from five international groups.

The first joint guidelines on the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death outline invasive and noninvasive techniques.

They also advise how to treat specific populations, such as athletes, elderly patients, children and pregnant women.

The American College of Cardiology, the American Heart Association and the European Society of Cardiology released the guidelines in collaboration with the European Heart Rhythm Society and the Heart Rhythm Society.

One update includes implantation devices that now have a range of ejection fractions.

Douglas P. Zipes

The updated guidelines are important because they now encompass all evidence-based trials and attempt to include all populations, according to Douglas P. Zipes, MD, section editor of the Electrophysiology and Arrhythmia Disorders section of Cardiology Today and professor emeritus of medicine, pharmacology and toxicology at Indiana School of Medicine in Indianapolis.

One major aspect of the guidelines is approval of all of the major cardiology organizations. It was a tour de force trying to reach agreement among the groups, Zipes said.

However, countries are able to modulate the recommendation based on their own needs and populations, he said.

Guidelines and classes

The committee that prepared the recommendations grouped them into three classes. Class I included conditions for which evidence or general agreement that a procedure or treatment is useful, and are recommended by the committee.

Class II included conditions for which there is conflicting evidence or opinion about the effectiveness of a treatment; Class IIa included conditions for which the evidence is in favor of the treatment, and Class IIb included conditions for which the evidence is less established.

The committee said that it is reasonable to perform procedures included in Class IIa, and those in Class IIb may be considered.

Class III included conditions for which evidence suggests that a treatment is either harmful or ineffective. The committee does not recommend procedures or treatments included in Class III.

In addition, the committee classified levels of evidence as A, which included data obtained from several randomized clinical trials; B, which included data obtained from a single randomized trial; and C, which included evidence derived only from case studies, expert opinions or standard-of-care.

The committee included invasive and noninvasive techniques, including electrocardiography and electrophysiological testing.

In addition, they included acute and chronic therapies, such as ablation, devices, pharmacological methods, revascularization and surgery.

Their classifications included ambulatory electrocardiography, antiarrhythmic drugs, exercise testing, left ventricular function and imaging, and resting electrocardiogram.

The committee said that although the recommendations are lengthy, further research addressing sudden cardiac death will lead to further recommendations and updates. – by Lauren Riley

For more information:

• ACC/AHA/ESC. 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Circulation. 2006;114:385-484.