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      2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias

      research-article
      , MB, BCh, BAO, FHRS, CCDS, CEPS-A 1 , , MD 2 , , MD 3 , , MD, PhD 4 , , MD, PhD, FHRS 5 , , MBBS, MD 6 , , MD, PhD, FESC, FACC 7 , , MD, PhD, FHRS 8 , , MD, MHS, FHRS, CCDS 9 , , MD 10 , , MD, PhD 11 , , MD, FHRS, CCDS 12 , , MD, FHRS 13 , , MD 14 , , MD, PhD 15 , , MD, FACC 16 , , MD 17 , , MD, PhD, FHRS 18 , , MD, PhD, FACC, FHRS 19 , , MD 20 , , MBBS, PhD, FHRS 21 , , MD, CCDS 22 , , MD, FHRS 2 , , MD, FHRS 12 , , MD, FHRS 23 , , MD, PhD 24 , , MD, FHRS, CEPS-P 25 , , MBBS, PhD, FHRS 26 , , MD 27 , , MD, PhD 12 , , MD, FHRS 28 , , MD, PhD, FEHRA 29 , , MD 30 , , MD, FHRS 31 , , MD, MS, FHRS 32 , , MD, FHRS 33 , , MD, PhD 13 , , MD, PhD, FESC, FEHRA 34
      Heart rhythm
      Catheter ablation, Clinical document, Electrical storm, Electroanatomical mapping, Electrocardiogram, Expert consensus statement, Imaging, Premature ventricular complex, Radiofrequency ablation, Ventricular arrhythmia, Ventricular tachycardia

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          Abstract

          Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

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          Most cited references1,111

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          2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.

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            Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study.

            Renal sympathetic hyperactivity is associated with hypertension and its progression, chronic kidney disease, and heart failure. We did a proof-of-principle trial of therapeutic renal sympathetic denervation in patients with resistant hypertension (ie, systolic blood pressure >/=160 mm Hg on three or more antihypertensive medications, including a diuretic) to assess safety and blood-pressure reduction effectiveness. We enrolled 50 patients at five Australian and European centres; 5 patients were excluded for anatomical reasons (mainly on the basis of dual renal artery systems). Patients received percutaneous radiofrequency catheter-based treatment between June, 2007, and November, 2008, with subsequent follow-up to 1 year. We assessed the effectiveness of renal sympathetic denervation with renal noradrenaline spillover in a subgroup of patients. Primary endpoints were office blood pressure and safety data before and at 1, 3, 6, 9, and 12 months after procedure. Renal angiography was done before, immediately after, and 14-30 days after procedure, and magnetic resonance angiogram 6 months after procedure. We assessed blood-pressure lowering effectiveness by repeated measures ANOVA. This study is registered in Australia and Europe with ClinicalTrials.gov, numbers NCT 00483808 and NCT 00664638. In treated patients, baseline mean office blood pressure was 177/101 mm Hg (SD 20/15), (mean 4.7 antihypertensive medications); estimated glomerular filtration rate was 81 mL/min/1.73m(2) (SD 23); and mean reduction in renal noradrenaline spillover was 47% (95% CI 28-65%). Office blood pressures after procedure were reduced by -14/-10, -21/-10, -22/-11, -24/-11, and -27/-17 mm Hg at 1, 3, 6, 9, and 12 months, respectively. In the five non-treated patients, mean rise in office blood pressure was +3/-2, +2/+3, +14/+9, and +26/+17 mm Hg at 1, 3, 6, and 9 months, respectively. One intraprocedural renal artery dissection occurred before radiofrequency energy delivery, without further sequelae. There were no other renovascular complications. Catheter-based renal denervation causes substantial and sustained blood-pressure reduction, without serious adverse events, in patients with resistant hypertension. Prospective randomised clinical trials are needed to investigate the usefulness of this procedure in the management of this condition.
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              Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure.

              Sudden death from cardiac causes remains a leading cause of death among patients with congestive heart failure (CHF). Treatment with amiodarone or an implantable cardioverter-defibrillator (ICD) has been proposed to improve the prognosis in such patients. We randomly assigned 2521 patients with New York Heart Association (NYHA) class II or III CHF and a left ventricular ejection fraction (LVEF) of 35 percent or less to conventional therapy for CHF plus placebo (847 patients), conventional therapy plus amiodarone (845 patients), or conventional therapy plus a conservatively programmed, shock-only, single-lead ICD (829 patients). Placebo and amiodarone were administered in a double-blind fashion. The primary end point was death from any cause. The median LVEF in patients was 25 percent; 70 percent were in NYHA class II, and 30 percent were in class III CHF. The cause of CHF was ischemic in 52 percent and nonischemic in 48 percent. The median follow-up was 45.5 months. There were 244 deaths (29 percent) in the placebo group, 240 (28 percent) in the amiodarone group, and 182 (22 percent) in the ICD group. As compared with placebo, amiodarone was associated with a similar risk of death (hazard ratio, 1.06; 97.5 percent confidence interval, 0.86 to 1.30; P=0.53) and ICD therapy was associated with a decreased risk of death of 23 percent (0.77; 97.5 percent confidence interval, 0.62 to 0.96; P=0.007) and an absolute decrease in mortality of 7.2 percentage points after five years in the overall population. Results did not vary according to either ischemic or nonischemic causes of CHF, but they did vary according to the NYHA class. In patients with NYHA class II or III CHF and LVEF of 35 percent or less, amiodarone has no favorable effect on survival, whereas single-lead, shock-only ICD therapy reduces overall mortality by 23 percent. Copyright 2005 Massachusetts Medical Society.
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                Author and article information

                Contributors
                Role: (Chair)
                Role: (Vice-Chair)
                Role: (EHRA Chair)
                Role: (EHRA Vice-Chair)
                Role: (APHRS Chair)
                Role: (APHRS Vice-Chair)
                Role: (LAHRS Chair)
                Role: (LAHRS Vice-Chair)
                Journal
                101200317
                32383
                Heart Rhythm
                Heart Rhythm
                Heart rhythm
                1547-5271
                1556-3871
                13 September 2021
                10 May 2019
                January 2020
                21 September 2021
                : 17
                : 1
                : e2-e154
                Affiliations
                [1 ]Hartford Hospital, Hartford, Connecticut
                [2 ]University of Michigan, Ann Arbor, Michigan
                [3 ]University Hospital Rangueil, Toulouse, France
                [4 ]Institute for Clinical and Experimental Medicine, Prague, Czech Republic
                [5 ]Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
                [6 ]Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
                [7 ]Centro Privado de Cardiología, Tucuman, Argentina
                [8 ]Instituto Brasília de Arritmia, Brasília, Brazil
                [9 ]Duke University Medical Center, Durham, North Carolina
                [10 ]Beth Israel Deaconess Medical Center, Boston, Massachusetts
                [11 ]Heart Institute, Teknon Medical Center, Barcelona, Spain
                [12 ]University of Pennsylvania, Philadelphia, Pennsylvania
                [13 ]Cleveland Clinic, Cleveland, Ohio
                [14 ]Washington University School of Medicine, St. Louis, Missouri
                [15 ]Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
                [16 ]Northwestern University Feinberg School of Medicine, Chicago, Illinois
                [17 ]Ospedale San Raffaele, Milan, Italy
                [18 ]Herz- und Gefäβ-Klinik, Bad Neustadt, Germany
                [19 ]University of Maryland, Baltimore, Maryland
                [20 ]Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
                [21 ]University of Queensland, The Prince Charles Hospital, Chermside, Australia
                [22 ]University of Alabama at Birmingham, Birmingham, Alabama
                [23 ]Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
                [24 ]University of Tsukuba, Ibaraki, Japan
                [25 ]University of California San Francisco Benioff Children’s Hospital, San Francisco, California
                [26 ]Australian National University, Canberra Hospital, Canberra, Australia
                [27 ]CardioInfantil Foundation, Cardiac Institute, Bogota, Columbia
                [28 ]Queen Elizabeth II Health Sciences Centre, Halifax, Canada
                [29 ]University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
                [30 ]Kyorin University School of Medicine, Tokyo, Japan
                [31 ]Vanderbilt University Heart and Vascular Center, Nashville, Tennessee
                [32 ]Brigham and Women’s Hospital, Boston, Massachusetts
                [33 ]University of Colorado Denver, Aurora, Colorado
                [34 ]Leiden University Medical Center, Leiden, the Netherlands
                Author notes
                [*]

                Representative of the European Heart Rhythm Association (EHRA)

                [†]

                Representative of the American College of Cardiology (ACC)

                [‡]

                Representative of the Sociedade Brasileira de Arritmias Cardíacas (SOBRAC)

                [§]

                Representative of the American Heart Association (AHA)

                [¶]

                Representative of the Latin American Heart Rhythm Society (LAHRS)

                [#]

                Representative of the Asia Pacific Heart Rhythm Society (APHRS)

                [**]

                Representative of the Japanese Heart Rhythm Society (JHRS)

                [††]

                Representative of the Pediatric and Congenital Electrophysiology Society (PACES)

                Correspondence: Heart Rhythm Society, 1325GStreet NW, Suite 400, Washington, DC20005. clinicaldocs@ 123456hrsonline.org .
                Article
                NIHMS1737000
                10.1016/j.hrthm.2019.03.002
                8453449
                31085023
                e539ef2f-2368-497f-9d1f-f39c5e3a4a21

                This article is published under the Creative Commons CC-BY license.

                History
                Categories
                Article

                Cardiovascular Medicine
                catheter ablation,clinical document,electrical storm,electroanatomical mapping,electrocardiogram,expert consensus statement,imaging,premature ventricular complex,radiofrequency ablation,ventricular arrhythmia,ventricular tachycardia

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