2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death
Sudden cardiac death (SCD) and ventricular arrhythmias (VA) are a global health issue and can be caused by several diseases. In August 2022, the European Guidelines of the European Society of Cardiology (ESC) on the prevention and treatment of these diseases were published (https://doi.org/10.1093/eurheartj/ehac262). The new guidelines serve as an update to the 2015 ESC guideline on this topic and aims to help cardiologists towards the best treatment and follow-up, to prevent new life-threatening arrhythmias and even sudden cardiac death.
In a number of ways, the new guidelines are bringing new knowledge and improved care to the table. Public resuscitation efforts (basic life support) and access to defibrillators have markedly shown to increase the chance of surviving a cardiac arrest and are hence now a guideline topic. For patients with new-onset arrhythmia (whether cardiac arrest or not) novel flowcharts now guide the cardiologist towards the correct treatment and the recommended investigations. Due to the increased knowledge emerged in the last decade attention is now put on the importance of (early) genetic testing and cardiac magnetic resonance imaging for better risk stratification of patients, an assessment of how high the patient’s individual risk is for dangerous arrhythmias or sudden cardiac death. Safe drug use and the relevance of treatment with catheter ablation in patients with VA has also become an important add-on. Regarding risk stratification for sudden death, during the latter years risk calculators have been proposed for some diseases, considering several variables related to the specific disease. These have been carefully reviewed and included where appropriate. Generally, new risk markers beyond the “conventional” left ventricular ejection fraction (LVEF), a measure of the pump force of the heart, are increasingly considered for recommendations on preventive implantable cardioverter defibrillator (ICD) therapy (referred to as primary prevention which means that an ICD is implanted because of a high risk of a potentially life-threatening arrhythmia, which is in contrast to secondary prevention, where an ICD is implanted after someone has survived a life-threatening arrhythmia). With many comprehensive flowcharts and practical algorithms, the novel guideline takes a step towards a user-oriented reference book which should in turn aid us in the fight to reduce the global burden of ventricular arrhythmias and sudden cardiac death. As a novel feature the user-oriented ESC 2022 VA+SCD app is a very useful clinical decision support tool for doctors.
Translated by Bo Gregers Winkel1 and Jacob Tfelt-Hansen1,2
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark
Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M; ESC Scientific Document Group, Cikes M, Kirchhof P, Abdelhamid M, Aboyans V, Arbelo E, Arribas F, Asteggiano R, Basso C, Bauer A, Bertaglia E, Biering-Sørensen T, Blomström-Lundqvist C, Borger MA, Čelutkienė J, Cosyns B, Falk V, Fauchier L, Gorenek B, Halvorsen S, Hatala R, Heidbuchel H, Kaab S, Konradi A, Koskinas KC, Kotecha D, Landmesser U, Lewis BS, Linhart A, Løchen ML, Lund LH, Metzner A, Mindham R, Nielsen JC, Norekvål TM, Patten M, Prescott E, Rakisheva A, Remme CA, Roca-Luque I, Sarkozy A, Scherr D, Sitges M, Touyz RM, Van Mieghem N, Velagic V, Viskin S, Volders PGA. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022 Oct 21;43(40):3997-4126. doi: 10.1093/eurheartj/ehac262. PMID: 36017572.