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JAMA Cardiology Clinical Guidelines Synopsis
April 11, 2018

Management of Ventricular Arrhythmias and Sudden Cardiac Death Risk Related to Ischemic and Nonischemic Cardiomyopathy

Author Affiliations
  • 1Division of Cardiology and Duke Clinical Research Institute, Duke University Hospital, Durham, North Carolina
  • 2Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee
JAMA Cardiol. Published online April 11, 2018. doi:10.1001/jamacardio.2018.0016

Ventricular arrhythmias are a major cause of morbidity and mortality and they account for a substantial number of SCDs.1 Therefore, it is imperative for clinicians to identify patients at risk of developing VAs and SCD and to intervene promptly to reduce that risk. Patients with ischemic cardiomyopathy or NICM can be at a high risk of VAs and SCD.1,2 Therefore, when such patients present with syncope for which VA is documented or suspected, they should be hospitalized for evaluation, monitoring, and management. The workup of patients presenting with symptoms suggestive of VAs should include a 12-lead electrocardiogram; ambulatory electrocardiographic monitoring, and if needed, an implantable loop recorder; and noninvasive and/or invasive imaging studies to assess heart function and rule out ischemic heart disease when indicated.2 In some patients, an electrophysiology study may be needed.2 Even in the absence of symptoms, some patients with ischemic cardiomyopathy or NICM warrant implantation of an ICD to reduce the risk of SCD.2

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