Management of ventricular arrhythmias in structural heart disease

Abstract

Ventricular arrhythmias (VA) are a source of significant morbidity and mortality in patients with structural heart disease (SHD). The advent of the implantable cardiac defibrillator (ICD) has had a positive effect on mortality, but the associated morbidity remains a significant problem. Modern treatment of VA has advanced far beyond medical therapy and includes strategies as simple as intelligent ICD programming and as complex as catheter ablation (CA). In these pages, the spectrum of management strategies will be discussed; from anti-arrhythmic drugs and ICD implantation and programming to CA and autonomic modulation. The focus of this review will be on strategies for secondary prevention of VA in patients with SHD, supported by clinical evidence for their utilization.

Keywords:

• Ventricular tachycardia
• ventricular fibrillation
• cardiomyopathy
• ablation
• implantable defibrillator
• sympathetic denervation

Declaration of interest

JT Jacobson has been a consultant to St Jude Medical and received research support from Biosense Webster in the past year. S Iwai has been a consultant to Biosense Webster, has received honoraria from Medtronic and St. Jude Medical, and been on the Data and Safety Monitoring Board of and received honoraria from BIOTRONIK. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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