ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death--executive summary: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society

doi:10.1093/eurheartj/ehl199

European Heart Journal 2006 27(17):2099-2140; doi:10.1093/eurheartj/ehl199

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© 2006 by the American College of Cardiology Foundation, the American Heart Association, Inc, and the European Society of Cardiology. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death—executive summary

A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society

Authors/Task Force Members, Douglas P. Zipes, MD, MACC, FAHA, FESC, Co-Chair, A. John Camm, MD, FACC, FAHA, FESC, Co-Chair, Martin Borggrefe, MD, FESC, Alfred E. Buxton, MD, FACC, FAHA, Bernard Chaitman, MD, FACC, FAHA, Martin Fromer, MD, Gabriel Gregoratos, MD, FACC, FAHA, George Klein, MD, FACC, Arthur J. Moss, MD, FACC, FAHA, Robert J. Myerburg, MD, FACC, FAHA, Silvia G. Priori, MD, PhD, FESC^*, Miguel A. Quinones, MD, FACC, Dan M. Roden, MD, CM, FACC, FAHA, Michael J. Silka, MD, FACC, FAHA and Cynthia Tracy, MD, FACC, FAHA

ESC Committee for Practice Guidelines, Silvia G. Priori, MD, PhD, FESC, Chair, Jean-Jacques Blanc, MD, FESC, Andrzej Budaj, MD, FESC, A. John Camm, MD, FESC, FACC, FAHA, Veronica Dean, Jaap W. Deckers, MD, FESC, Catherine Despres, Kenneth Dickstein, MD, PhD, FESC, John Lekakis, MD, FESC, Keith McGregor, PhD, Marco Metra, MD, Joao Morais, MD, FESC, Ady Osterspey, MD, Juan Luis Tamargo, MD, FESC and José Luis Zamorano, MD, FESC

France
Poland
United Kingdom
France
the Netherlands
France
Norway
Greece
France
Italy
Portugal
Germany
Spain
Spain

ACC/AHA (Practice Guidelines) Task Force Members, Sidney C. Smith, Jr, MD, FACC, FAHA, FESC, Chair, Alice K. Jacobs, MD, FACC, FAHA, Vice-Chair, Cynthia D. Adams, MSN, APRN-BC, FAHA, Elliott M. Antman, MD, FACC, FAHA, Jeffrey L. Anderson, MD, FACC, FAHA, Sharon A. Hunt, MD, FACC, FAHA, Jonathan L. Halperin, MD, FACC, FAHA, Rick Nishimura, MD, FACC, FAHA, Joseph P. Ornato, MD, FACC, FAHA, Richard L. Page, MD, FACC, FAHA and Barbara Riegel, DNSc, RN, FAHA

The first 150 words of the full text of this article appear below.

Preamble

It is important that the medical profession play a significantrole in critically evaluating the use of diagnostic proceduresand therapies as they are introduced and tested in the detection,management, or prevention of disease states. Rigorous and expertanalysis of the available data documenting absolute and relativebenefits and risks of those procedures and therapies can producehelpful guidelines that improve the effectiveness of care, optimizepatient outcomes, and favorably affect the overall cost of careby focusing resources on the most effective strategies.

The American College of Cardiology Foundation (ACCF) and theAmerican Heart Association (AHA) have jointly engaged in theproduction of such guidelines in the area of cardiovasculardisease since 1980. The ACC/AHA Task Force on Practice Guidelines,whose charge is to develop, update, or revise practice guidelinesfor important cardiovascular diseases and procedures, directsthis effort. The Task Force is pleased to have this guideline. . . [Full Text of this Article]

   I. Introduction

A. Prophylactic implantable cardioverter-defibrillator recommendations across published guidelines
B. Classification of ventricular arrhythmias and sudden cardiac death

   II. Incidence of sudden cardiac death

   III. Clinical presentations of patients with ventricular arrhythmias and sudden cardiac death

   IV. Resting electrocardiography

   V. Exercise testing

   VI. Ambulatory electrocardiography

   VII. Electrocardiographic techniques and measurements

   VIII. Left ventricular function and imaging

A. Echocardiography
B. Radionuclide techniques
C. Coronary angiography

   IX. Electrophysiological testing

A. Electrophysiological testing in patients with coronary heart disease
B. Electrophysiological testing in patients with syncope

   X. Value of antiarrhythmic drugs

A. Beta blockers
B. Amiodarone and sotalol

   XI. Special considerations where antiarrhythmic drugs may be indicated

A. Patients with ventricular tachyarrhythmias who do not meet criteria for an implantable cardioverter-defibrillator
B. Patients with implantable cardioverter-defibrillators who have recurrent ventricular tachycardia/ventricular fibrillation with frequent appropriate implantable cardioverter-defibrillator firing

   XII. Implantable and external cardioverter devices

A. Automated external defibrillator
B. Ablation
C. Antiarrhythmic surgery
D. Revascularization for arrhythmia management

   XIII. Acute management of specific arrhythmias

A. Management of cardiac arrest
B. Arrhythmias associated with acute coronary syndromes
C. Ventricular tachycardia associated with low troponin myocardial infarction
D. Sustained monomorphic ventricular tachycardia
E. Repetitive monomorphic ventricular tachycardia
F. Polymorphic ventricular tachycardia
G. Torsades de pointes
H. Incessant ventricular tachycardia
I. Clinical features

   XIV. Ventricular arrhythmia and sudden cardiac death related to specific pathology

A. Left ventricular dysfunction due to prior myocardial infarction
B. Valvular heart disease
C. Congenital heart disease
D. Metabolic and inflammatory conditions
1. Myocarditis, rheumatic disease, and endocarditis
2. Infiltrative cardiomyopathies
3. Endocrine disorders and diabetes
4. End-stage renal failure
5. Obesity, dieting, and anorexia
E. Pericardial diseases
F. Pulmonary arterial hypertension
G. Transient arrhythmias of reversible cause

   XV. Ventricular arrhythmias associated with cardiomyopathies

A. Dilated cardiomyopathy (nonischemic)
Risk stratification
Genetic analysis
B. Hypertrophic cardiomyopathy
Risk stratification
Management
Genetic analysis
C. Arrhythmogenic right ventricular cardiomyopathy
Risk stratification
Management
Genetic analysis
D. Neuromuscular disorders

   XVI. Heart failure

   XVII. Genetic arrhythmia syndromes

A. General concepts for risk stratification
B. Long QT syndrome
Lifestyle changes
Genetic analysis
Andersen syndrome
C. Short QT syndrome and Brugada syndrome
Genetic analysis—Brugada syndrome
Genetic analysis—short QT syndrome
D. Catecholaminergic polymorphic ventricular tachycardia
Genetic analysis

   XVIII. Arrhythmias in structurally normal hearts

A. Idiopathic ventricular tachycardia
Demographics and presentation of outflow tract ventricular tachycardia
B. Electrolyte disturbances
C. Physical and toxic agents
D. Smoking
E. Lipids

   XIX. Ventricular arrhythmias and sudden cardiac death related to specific populations

A. Athletes
B. Gender and pregnancy
QT interval
C. Elderly patients
D. Pediatric patients
E. Patients with implantable cardioverter-defibrillators
F. Digitalis toxicity
G. Drug-induced long QT syndrome
H. Sodium channel blocker–related toxicity
I. Tricyclic antidepressant overdose
J. Other drug-induced toxicity

   XX. Conclusions

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