Cardiac arrhythmias in coronary heart disease

Coronary heart disease is associated with many cardiac arrhythmias, with wide-ranging clinical consequences. Arrhythmias are common during acute coronary syndrome (ACS), with ventricular tachyarrhythmias being an important cause of cardiac arrest and sudden cardiac deaths (SCD) in this context. Patients with chronic CHD, particularly those with left ventricular dysfunction and heart failure are also at risk of ventricular arrhythmia and SCD in the longer term. An increasing number of patients with CHD are also affected by atrial fibrillation (AF) which is associated with significant morbidity as well as an increased risk of stroke and death, particularly in patients with other comorbid conditions such as heart failure.

Remit and target users

This guideline provides evidence-based recommendations for the management of cardiac arrest and the arrhythmias associated with ACS, chronic CHD and cardiac surgery. It excludes arrhythmias not associated with CHD such as supraventricular tachycardias associated with accessory pathways or dual atrioventricular (AV) nodal physiology, arrhythmias caused by inherited ion channel disorders (eg long QT syndrome, Brugada syndrome) and arrhythmias associated with non-ischaemic cardiomyopathies. The evidence base in some areas (for example, management of cardiac arrest and atrial fibrillation) does not distinguish between patients whose arrhythmia has an ischaemic or non-ischaemic aetiology but wherever possible, the recommendations made are specific to CHD.

This guideline will be of interest to healthcare professionals involved in the management of patients with cardiac arrhythmias including cardiac surgeons, cardiac nurse specialists cardiologists, clinical psychologists, general practitioners and other members of the primary care team, paramedics and pharmacists, as well as patients, carers and voluntary organisations.

How this guideline was developed

This guideline was developed using a standard methodology based on a systematic review of the evidence. Further details can be found in SIGN 50: A Guideline Developer’s Handbook.

Keeping up to date

This guideline was published in 2018 and will be considered for review in three years. The review history, and any updates to the guideline in the interim period, will be noted in the review report.

Current 3-7 years