Solomon SD, Zelenkofske S, McMurray JJ, et al; Valsartan in Acute Myocardial Infarction Trial (VALIANT) Investigators. Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both. N Engl J Med. 2005;352:2581-2588. Abstract
Pouleur AC, Barkoudah E, Uno H, et al. Pathogenesis of sudden unexpected death in a clinical trial of patients with myocardial infarction and left ventricular dysfunction, heart failure, or both. Circulation. 2010; 122:597-602. Abstract
Dorian P, Hohnloser SH, Thorpe KE, et al. Mechanisms underlying the lack of effect of implantable cardioverter-defibrillator therapy on mortality in high-risk patients with recent myocardial infarction: insights from the Defibrillation in Acute Myocardial Infarction Trial (DINAMIT). Circulation. 2010;122:2645-2652. Abstract
Steinbeck G, Andresen D, Seidl K, et al; IRIS Investigators. Defibrillator implantation early after myocardial infarction. N Engl J Med. 2009; 361:1427-1436. Abstract
Bigger JT Jr. Prophylactic use of implanted cardiac defibrillators in patients at high risk for ventricular arrhythmias after coronary-artery bypass graft surgery. Coronary Artery Bypass Graft (CABG) Patch Trial Investigators. N Engl J Med. 1997;337:1569-1575. Abstract
Hauptman PJ, Swindle JP, Masoudi FA, et al. Underutilization of beta-blockers in patients undergoing implantable cardioverter-defibrillator and cardiac resynchronization procedures. Circ Cardiovasc Qual Outcomes. 2010; 2:204-211.
Pitt B, Williams G, Remme W, et al. The EPHESUS trial: eplerenone in patients with heart failure due to systolic dysfunction complicating acute myocardial infarction. Eplerenone Post-AMI Heart Failure Efficacy and Survival Study. Cardiovasc Drugs Ther 2001;15:79-87.
Poole-Wilson PA, Uretsky BF, Thygesen K, Cleland JG, Massie BM, Rydén L; Atlas Study Group. Assessment of treatment with lisinopril and survival. Mode of death in heart failure: findings from the ATLAS trial. Heart. 2003;89: 42-48. Abstract
Centers for Medicare and Medicaid Services. Department of Health and Human Services. CMS Manual System, Pub. 100-03 Medicare National Coverage Determinations. Available at: http://www.cms.gov/transmittals/downloads/R29NCD.pdf. Published March 4, 2005. Accessed April 11, 2013.
Russo AM, Stainback RF, Bailey SR, et al. ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 Appropriate Use Criteria for Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2013;61:1318-1368. Abstract
Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114:e385-e484. Abstract
Bardy GH, Lee KL, Mark DB, et al; HAT Investigators. Home use of automated external defibrillators for sudden cardiac arrest. N Engl J Med. 2008;358:1793-1804. Abstract
Kadish A, Dyer A, Daubert JP, et al. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) Investigators. N Engl J Med. 2004;350:2151-2158. Abstract
Chung MK, Szymkiewicz SJ, Shao M, et al. Aggregate national experience with the wearable cardioverter-defibrillator: event rates, compliance, and survival. J Am Coll Cardiol. 2010;56:194-203. Abstract

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Authors

John Chin, MD

Director, Advanced Heart Failure and Cardiac Transplant Program, Sutter Memorial Hospital, Sacramento, California; Associate Clinical Professor of Medicine, University of California, Davis

Disclosures

Disclosure: John Chin, MD, has disclosed no relevant financial relationships.

Dr Chin does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States

Dr Chin does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Owen A. Obel, MD, MRCP

Chief, Cardiac Pacing and Electrophysiology, Dallas VA Medical Center; Assistant Professor of Medicine, Director of Education, Electrophysiology Fellowship, The University of Texas Southwestern Medical Center, Dallas, Texas

Disclosures

Disclosure: Owen A. Obel, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Medtronic, Inc.
Served as a speaker or a member of a speakers bureau for: Boehringer Ingelheim Pharmaceuticals, Inc.; Medtronic, Inc.; St. Jude Medical; Zoll Medical Corporation

Dr Obel does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Obel does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editors

Ron Miller, PhD

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Ron Miller, PhD, has disclosed no relevant financial relationships.

Kathleen Walsh Tulley

Clinical Editor, Medscape, LLC

Disclosures

Disclosure: Kathleen Walsh Tulley has disclosed no relevant financial relationships.

CME Reviewer

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

CME

Managing the Risk of Sudden Cardiac Death in Nonischemic Patients

Authors: John Chin, MD; Owen A. Obel, MD, MRCP
CME Released: 3/16/2012; Reviewed and Renewed: 6/16/2014
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 6/16/2015

Start Activity

Target Audience and Goal Statement

This activity is intended for heart failure specialists, interventional cardiologists, electrophysiologists, general cardiologists, cardiac nurses, and other healthcare professionals involved in the care of patients at risk for sudden cardiac arrest.

The goal of this activity is to improve the understanding of management options for the primary prevention of sudden cardiac death in patients diagnosed with nonischemic cardiomyopathy.

Upon completion of this activity, participants will be able to:

Describe the importance of using ejection fraction in identifying the risk of sudden cardiac death in patients with nonischemic cardiomyopathy
Discuss treatment options for patients with nonischemic cardiomyopathy at risk for sudden cardiac death

Disclosures

Authors

John Chin, MD

Director, Advanced Heart Failure and Cardiac Transplant Program, Sutter Memorial Hospital, Sacramento, California; Associate Clinical Professor of Medicine, University of California, Davis

Disclosures

Disclosure: John Chin, MD, has disclosed no relevant financial relationships.

Dr Chin does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States

Dr Chin does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Owen A. Obel, MD, MRCP

Chief, Cardiac Pacing and Electrophysiology, Dallas VA Medical Center; Assistant Professor of Medicine, Director of Education, Electrophysiology Fellowship, The University of Texas Southwestern Medical Center, Dallas, Texas

Disclosures

Disclosure: Owen A. Obel, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Medtronic, Inc.
Served as a speaker or a member of a speakers bureau for: Boehringer Ingelheim Pharmaceuticals, Inc.; Medtronic, Inc.; St. Jude Medical; Zoll Medical Corporation

Dr Obel does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Obel does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editors

Ron Miller, PhD

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Ron Miller, PhD, has disclosed no relevant financial relationships.

Kathleen Walsh Tulley

Clinical Editor, Medscape, LLC

Disclosures

Disclosure: Kathleen Walsh Tulley has disclosed no relevant financial relationships.

CME Reviewer

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

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From Medscape Education Cardiology

CME

Managing the Risk of Sudden Cardiac Death in Nonischemic Patients

Authors: John Chin, MD; Owen A. Obel, MD, MRCPFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME Released: 3/16/2012; Reviewed and Renewed: 6/16/2014

Valid for credit through: 6/16/2015

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Considerable controversy exists regarding the implantation of an internal cardioverter-defibrillator in patients who are considered high risk, but do not fulfill current guidelines for receiving such a device. This is clearly the case with patients diagnosed with nonischemic cardiomyopathy who have left ventricular dysfunction. During the waiting period to determine if there is improvement in ventricular function, the patient is vulnerable to ventricular ectopy and sudden cardiac death. Drs John Chin and Owen Obel discuss how the wearable cardioverter-defibrillator can get patients through this critical period.

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The educational activity presented above may involve simulated case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient is intended or should be inferred.

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on medscape.org. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

References

Faculty and Disclosures

Authors

John Chin, MD

Owen A. Obel, MD, MRCP

Editors

Ron Miller, PhD

Kathleen Walsh Tulley

CME Reviewer

Nafeez Zawahir, MD

CME

Managing the Risk of Sudden Cardiac Death in Nonischemic Patients

Target Audience and Goal Statement

Disclosures

Authors

John Chin, MD

Owen A. Obel, MD, MRCP

Editors

Ron Miller, PhD

Kathleen Walsh Tulley

CME Reviewer

Nafeez Zawahir, MD

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Managing the Risk of Sudden Cardiac Death in Nonischemic Patients