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Recurrent VT in Ischaemic HFrEF — EECC MCQ

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ModerateHeart FailureRecurrent VT in Ischaemic HFrEFEECC

A 50-year-old man with chronic HFrEF (LVEF 22%) and ischaemic aetiology develops new-onset sustained monomorphic VT during an outpatient appointment. He has an ICD in situ. The VT is haemodynamically tolerated (BP 105/70 mmHg). His ICD delivers anti-tachycardia pacing which terminates the VT. What is the most important long-term management consideration?

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Correct answer: E — Amiodarone initiation and referral for catheter ablation of VT

In patients with ischaemic cardiomyopathy and recurrent sustained VT despite ICD therapy, catheter ablation should be considered to reduce VT burden and ICD therapies (Class IIa per ESC 2022 VA/SCD Guidelines). Amiodarone is recommended as adjunctive pharmacotherapy to reduce VT recurrence (Class IIa). The combination of amiodarone with catheter ablation is more effective than either alone. Simply interrogating the ICD without addressing the arrhythmia substrate is insufficient. Mexiletine may be used as add-on to amiodarone in refractory cases.

Reference: ESC (2022): Guidelines on Ventricular Arrhythmias and Prevention of Sudden Cardiac Death