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2019 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Position Statement on The Management of Ventricular Tachycardia and Fibrillation in Patients with Structural Heart DiseaseSupplementary MaterialDisclosures:Supplementary Table S1: Members and disclosures of the primary and secondary panelsNameRelevant COIConsulting Fees/HonorariaConsulting Relationships RelevanceClinical Trials Funding Clinical trial relationships relevanceOtherOther Relationships RelevancePrimary Panel???????Marc W. DeyellYesAbbott Canada, BMS Pfizer, Boehringer Ingelheim, Johnson & Johnson, ServierNot relatedAbbott Canada, BMS Pfizer, Johnson & JohnsonEvaluation of novel ablation technologyNoneNoneJohn SappYesMedtronic, St. Jude Medical?St. Jude Medical?Johnson & JohnsonNonePaul AngaranYesBMS Pfizer, ServierNot relatedBayer, BMS Pfizer, Boehringer Ingelheim, Medtronic, St. Jude MedicalMost of these trials are unrelated. I am participating in several device (including ICD) trials and VANISH-2 (VT ablation vs. meds).NoneNoneAmir Abdel-WahabYesAbbott Canada, MedtronicThey are honoraria for participation in educational activities related to ICDsNoneNoneNoneNoneVidal EssebagYesAbbott Canada, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Johnson & Johnson, Medtronic, Novartis, Pfizer, ServierYesAbbott Canada, Bayer, BMS Pfizer, Boehringer Ingelheim, Boston Scientific, Johnson & Johnson, MedtronicSome of the companies listed sell devices or ablation catheters used to treat VTNoneNoneBenedict GloverYesBayer, ServierYesI have given presentations and received honoraria for these presentations which have focused on pacing and atrial fibrillation. I do not believe that these would have any impact on my opinions regarding the management of ventricular tachycardia.NoneI am recruiting patients for the MORE-CRT MPP study. This is relating to optimization of CRT for lv remodelling and symptom modification which is not related directly to the management of VT.Lorne GulaNoBayerNoNone?NoneNoneClarence KhooYesBayer, BMS PfizerYesNoneNo relationship to VT management in structural heart diseaseNoneNoneChris LaneNoBMS PfizerNoBayer, MedtronicNoneNoneNoneIsabelle NaultNoBayer, BMS Pfizer, ServierNoAbbott Canada, Boston Scientific, Medtronic, St. Jude MedicalNo relationship: not a local primary investigator for any of these studies.Johnson & Johnsonshares less than 10000$ - no relation to the guidelinePablo NeryNoNonen/aNonen/aNoneNoneHeather TullochNoNoneNoneNoneNoneNoneNoneMike Slawnych NoNovartisNo relationshipnonenonenonenone Lena RivardYesBayer, Boston Scientific, Johnson & Johnson, St. Jude MedicalYesBayer, St. Jude Medical, IcentiaNoneNoneNoneSecondary Panel???????Timothy Pollack NoNoneNoneNoneNoneNoneNoneVikas KuriachanYesAbbott Canada, Bayer, Boston Scientific, Johnson & Johnson, Medtronic, ServierYesAbbott Canada, Boston Scientific, Servier, St. Jude MedicalNone of them directly relate. However, J & J and Abbott do make catheters and EP equipment that are used in ablation of ventricular tachycardia at our center. Abbott, Medtronic, and Boston Scientific also make implantable defibrillators that are used in our centre.NoneAbbott / St. Jude medical - I was one of the local co-i on their leadless pacemaker study. BSC - Local co-i on their SICD vs Transvenous ICD study (ATLAS). Also local co-i on Watchman studies (ASAP-TOO and Stop HARM)Servier - Local co-i on afib ablation study with uninterrupted edoxabanEugene CrystalYesNoneNoneAbbott Canada, St. Jude Medical, Stereotaxis, BiotronikI am holding research grants from Stereotaxis, Biotronik and St JudeAbbott on image guided ablation therapies NoneNonePeter Leong-SitYesBayer, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Johnson & Johnson, Medtronic, Pfizer, St. Jude MedicalYesJohnson & Johnson, St. Jude MedicalConsulting fees and speaker honoraria from industry related to cardiac device (ICD) implantation, cardiac catheter ablation, and systemic anticoagulation.NoneClinical trials on cardiac ablation for VTPaul DorianYes Bayer, BMS Pfizer, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, ServierYesBayer, BMS Pfizer, Boehringer Ingelheim, Bristol-Myers Squibb, PfizerNo relation to the position statementNoneNoneJacqueline JozaYesBayer, BMS Pfizer, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, ServierYesBayer, BMS Pfizer, Boehringer Ingelheim, Bristol-Myers Squibb, PfizerNo relation to the position statementNoneNoneClassification and Mechanisms of Ventricular Tachycardia (VT) and Ventricular Fibrillation (VF) in Structural Heart DiseaseSupplementary Table S2: Classification and mechanisms of VT and VF in structural heart diseaseMonomorphic VTScar-Related Re-entry (most frequent)Previous myocardial infarctionScar from non-ischemic processes (myocarditis, ARVC, etc.)Purkinje System Re-entry (including bundle branch re-entry)Focal VT (enhanced automaticity or triggered activity)Acute ischemia (rare)No acute precipitant - abnormal myocardiumPolymorphic VT/VFNormal QT IntervalAcute ischemiaAcute decompensated heart failureNo acute precipitant – abnormal myocardium/repolarizationPremature ventricular complex/Purkinje triggeredProlonged QT Interval (torsade de pointes)Acquired long QT (drugs, electrolyte disturbance, hypothyroidism, ischemia)Concomitant congenital long QT syndrome and structural heart disease (rare)Abbreviations: ARVC, arrhythmogenic right ventricular cardiomyopathy.Intravenous Antiarrhythmic Drug Use in VT/VFSupplementary Table S3: Intravenous antiarrhythmic drug dosingDrugUnstable VT/VFStable VTCommentsAmiodaroneInitial bolus:300 mg IV push150 mg IV push if <100 lbs/45 kgSubsequent dose: (if ongoing VT/VF)150 mg IV pushInitial dose:150 mg IV over 10 min.Subsequent dose:1 mg/min. IV infusion for 6h Then 0.5 mg/min. IV for 18 hSlow or discontinue if QTc prolongation (≥500 ms with normal QRS)ProcainamideNot recommendedInitial dose:*10 mg/kg IV over 20 minSubsequent dose (if recurrent or ongoing VT):1-2 mg/minSlow the initial infusion rate if hypotension encounteredDiscontinue if QTc prolongation (≥550 ms with normal QRS)Discontinue if QRS prolongation (≥50% increase)LidocaineInitial bolus: ?100 mg IV push50 mg IV push if <100 lbs/45 kgSubsequent dose: (if ongoing VT/VF - give at least 10 minutes from initial)50 mg IV pushInitial dose:1 mg/kg IV over 1-2 min?Subsequent dose: (if recurrent/ongoing VT – give at least 10 minutes from initial)1-2 mg/minHave a high index of suspicion for neurotoxicity, (limit dose and duration)Discontinue if QRS prolongation (≥50% increase)*An initial dose of 10 mg/kg over 20 minutes had good efficacy and safety in a randomized trial.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5PcnRpejwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+PFJl
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ADDIN EN.CITE.DATA 2 but we favour a simplified initial dose in unstable VT/VF, for ease of administration.?Initial doses of up to 1.5 mg/kg have also been reported.Efficacy of Catheter Ablation of Monomorphic VT in Non-Ischemic CardiomyopathySupplementary Table S4: Studies evaluating outcomes of catheter ablation for VT in non-ischemic cardiomyopathyAuthorYearNLVEFEpicardial mapping and/or ablationFollow up in monthsVT Free on follow upMarchlinskiPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXJjaGxpbnNraTwvQXV0aG9yPjxZZWFyPjIwMDA8L1ll
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ADDIN EN.CITE.DATA 132013633430%2023%Kumar ADDIN EN.CITE <EndNote><Cite><Author>Kumar</Author><Year>2016</Year><RecNum>5063</RecNum><DisplayText><style face="superscript">14</style></DisplayText><record><rec-number>5063</rec-number><foreign-keys><key app="EN" db-id="5xrt0tv5nz0ptoerwrqxvd0z0z0s2wvvwdd0" timestamp="1477425705">5063</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kumar, S.</author><author>Romero, J.</author><author>Mehta, N. K.</author><author>Fujii, A.</author><author>Kapur, S.</author><author>Baldinger, S. H.</author><author>Barbhaiya, C. R.</author><author>Koplan, B. A.</author><author>John, R. M.</author><author>Epstein, L. M.</author><author>Michaud, G. F.</author><author>Tedrow, U. B.</author><author>Stevenson, W. G.</author></authors></contributors><auth-address>Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: wstevenson@.</auth-address><titles><title>Long-term outcomes after catheter ablation of ventricular tachycardia in patients with and without structural heart disease</title><secondary-title>Heart Rhythm</secondary-title></titles><periodical><full-title>Heart Rhythm</full-title></periodical><pages>1957-63</pages><volume>13</volume><number>10</number><edition>2016/07/10</edition><dates><year>2016</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1556-3871 (Electronic)
1547-5271 (Linking)</isbn><accession-num>27392945</accession-num><urls><related-urls><url>(16)30502-1 [pii]
10.1016/j.hrthm.2016.07.001</electronic-resource-num><language>Eng</language></record></Cite></EndNote>1420162394030% (cardiac sarcoidosis and ARVC included)7238%Abbreviations: LVEF, left ventricular ejection fraction; ARVC, arrhythmogenic right ventricular cardiomyopathy.Psychological Status Screening ToolsPersonal Health Questionnaire-2 ADDIN EN.CITE <EndNote><Cite><Author>Kroenke</Author><Year>2003</Year><RecNum>246</RecNum><DisplayText><style face="superscript">15</style></DisplayText><record><rec-number>246</rec-number><foreign-keys><key app="EN" db-id="xw9rvf9ri9e0x5e99topzt2npr2p2a22wed0" timestamp="1556168360" guid="bced32ef-a871-4402-86f3-a4e775b22f1b">246</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kroenke, Kurt</author><author>Spitzer, Robert L.</author><author>Janet, B. W. Williams</author></authors></contributors><titles><title>The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener</title><secondary-title>Medical Care</secondary-title></titles><periodical><full-title>Med Care</full-title><abbr-1>Medical care</abbr-1></periodical><pages>1284-1292</pages><volume>41</volume><number>11</number><dates><year>2003</year></dates><publisher>Lippincott Williams & Wilkins</publisher><isbn>00257079</isbn><urls><related-urls><url> publication date: Nov., 2003</custom1><remote-database-name>JSTOR</remote-database-name></record></Cite></EndNote>15This is a screening tool for depression.Over the last 2 weeks, how often have you been bother by the following problems?Not at allSeveral daysMore than half the daysNearly every dayLittle interest or pleasure in doing things0123Feeling down, depressed or hopeless0123Total score ranges from 0-6. A score of 3 or more represents a positive screening test for depression (further psychological assessment is required).Generalized Anxiety Disorder-2 Questionnaire ADDIN EN.CITE <EndNote><Cite><Author>Kroenke</Author><Year>2007</Year><RecNum>245</RecNum><DisplayText><style face="superscript">16</style></DisplayText><record><rec-number>245</rec-number><foreign-keys><key app="EN" db-id="xw9rvf9ri9e0x5e99topzt2npr2p2a22wed0" timestamp="1556167638" guid="25092881-abb3-4e42-8d5f-dd6a7f95b087">245</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kroenke, Kurt</author><author>Spitzer, Robert L.</author><author>Williams, Janet B.W.</author><author>Monahan, Patrick O.</author><author>L?we, Bernd</author></authors></contributors><titles><title>Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and DetectionAnxiety Disorders in Primary Care</title><secondary-title>Annals of Internal Medicine</secondary-title></titles><periodical><full-title>Annals of Internal Medicine</full-title></periodical><pages>317-325</pages><volume>146</volume><number>5</number><dates><year>2007</year></dates><isbn>0003-4819</isbn><urls><related-urls><url> is a screening tool for anxiety.Over the last 2 weeks, how often have you been bother by the following problems?Not at allSeveral daysMore than half the daysNearly every dayFeeling nervous, anxious or on edge0123Not being able to stop or control worrying0123Total score ranges from 0-6. A score of 3 or more represents a positive screening test for anxiety (further psychological assessment is required).Supplementary Material References: ADDIN EN.REFLIST 1.Ortiz M, Martin A, Arribas F, et al. Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study. Eur Heart J. 2017;38:1329-1335.2.Link MS, Berkow LC, Kudenchuk PJ, et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132:S444-464.3.Marchlinski FE, Callans DJ, Gottlieb CD, Zado E. Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy. Circulation. 2000;101:1288-1296.4.Hsia HH, Callans DJ, Marchlinski FE. Characterization of endocardial electrophysiological substrate in patients with nonischemic cardiomyopathy and monomorphic ventricular tachycardia. Circulation. 2003;108:704-710.5.Soejima K, Stevenson WG, Sapp JL, Selwyn AP, Couper G, Epstein LM. Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with dilated cardiomyopathy: the importance of low-voltage scars. J Am Coll Cardiol. 2004;43:1834-1842.6.Cesario DA, Vaseghi M, Boyle NG, et al. Value of high-density endocardial and epicardial mapping for catheter ablation of hemodynamically unstable ventricular tachycardia. Heart Rhythm. 2006;3:1-10.7.Cano O, Hutchinson M, Lin D, et al. Electroanatomic substrate and ablation outcome for suspected epicardial ventricular tachycardia in left ventricular nonischemic cardiomyopathy. J Am Coll Cardiol. 2009;54:799-808.8.Kuhne M, Abrams G, Sarrazin JF, et al. Isolated potentials and pace-mapping as guides for ablation of ventricular tachycardia in various types of nonischemic cardiomyopathy. J Cardiovasc Electrophysiol. 2010;21:1017-1023.9.Nakahara S, Tung R, Ramirez RJ, et al. Characterization of the arrhythmogenic substrate in ischemic and nonischemic cardiomyopathy implications for catheter ablation of hemodynamically unstable ventricular tachycardia. J Am Coll Cardiol. 2010;55:2355-2365.10.Schmidt B, Chun KR, Baensch D, et al. Catheter ablation for ventricular tachycardia after failed endocardial ablation: epicardial substrate or inappropriate endocardial ablation? Heart Rhythm. 2010;7:1746-1752.11.Haqqani HM, Tschabrunn CM, Tzou WS, et al. Isolated septal substrate for ventricular tachycardia in nonischemic dilated cardiomyopathy: incidence, characterization, and implications. Heart Rhythm. 2011;8:1169-1176.12.Vergara P, Trevisi N, Ricco A, et al. Late potentials abolition as an additional technique for reduction of arrhythmia recurrence in scar related ventricular tachycardia ablation. J Cardiovasc Electrophysiol. 2012;23:621-627.13.Dinov B, Fiedler L, Schonbauer R, et al. Outcomes in catheter ablation of ventricular tachycardia in dilated nonischemic cardiomyopathy compared with ischemic cardiomyopathy: results from the Prospective Heart Centre of Leipzig VT (HELP-VT) Study. Circulation. 2014;129:728-736.14.Kumar S, Romero J, Mehta NK, et al. Long-term outcomes after catheter ablation of ventricular tachycardia in patients with and without structural heart disease. Heart Rhythm. 2016;13:1957-1963.15.Kroenke K, Spitzer RL, Janet BWW. The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical care. 2003;41:1284-1292.16.Kroenke K, Spitzer RL, Williams JBW, Monahan PO, L?we B. Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and DetectionAnxiety Disorders in Primary Care. Annals of Internal Medicine. 2007;146:317-325. ................
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