Update 5/18: thanks to Tom Cascino for giving us another tip on localizing VT!
Take-home point: dual anti-platelet ACC/AHA guidelines changed as of 3/2016. The key points are:
- Dual anti-platelet therapy is needed post-DES for a minimum for 6 months (used to be 12 months)
- After this point, must individualize therapy based on risk of ischemia vs risk of bleeding. If the patient has high bleeding risk based on history, can stop at 6 months. If the patient had a high risk lesion and is at risk of cardiac ischemia, can extend therapy to 12 months
- Elective non-cardiac surgery should be postponed post-DES for 6 months (used to be 12 months)
Localizing VT focus: some rules of thumb
- Look at Lead I: if negative in lead I, the VT focus is coming from the lateral wall
- Look at inferior leads: if negative, the VT focus is coming from the inferior wall
- Look at aVR: if positive (NW axis), the VT focus is coming from the ventricles and heading towards the base (R shoulder)
- Look at bundle branch pattern: if LBBB, then VT focus is in the RV; if RBBB, then VT focus in the LV
- Look at V5,V6: if negative, the VT focus is coming from the apex (thanks to UCSF med graduate Tom Cascino, a cardiology fellow at Michigan for pointing this one out!)
For more on the management of VT, check out Lekshmi’s old blog post for excellent info.