Cardiology>>>>>Arrythmias
Question 13#

A 57-year-old patient with a history of dilated cardiomyopathy and an ejection fraction of 20% is admitted to hospital after a presyncopal episode. His ECG on arrival shows monomorphic VT with a rate of 80 bpm and his BP is 70/50 mmHg. He receives urgent cardioversion and his QRS complexes are narrow on return to sinus rhythm. He is normally NYHA class III and is on maximum medication for HF.

A. According to NICE criteria he does not qualify for an ICD as his aetiology is not IHD
B. He should receive a biventricular ICD
C. He should receive a standard ICD
D. He should be commenced on oral amiodarone
E. He should be considered for a VT ablation

Correct Answer is C

Comment:

NICE criteria regarding the need for the aetiology to be IHD only apply in the primary prevention setting, but this case describes the need for secondary prevention. The patient’s QRS is narrow; therefore a biventricular pacemaker is not indicated at present and it should be possible to programme the device so that pacing is not needed. The ICD will attempt to treat the monomorphic VT with ATP in this patient, and if this is successful there may well be no need to consider further suppression of VT with either medication or ablation.