266.2 📚 國考版

266.2.0.1 必背 — Spectrum

• PVCs: ectopic beats; benign usually; ablation if symptomatic/frequent + LV dysfunction
• NSVT: ≥ 3 beats < 30 sec
• Sustained VT: > 30 sec or hemodynamic compromise; monomorphic vs polymorphic
• VF: chaotic, no organized complexes
• Torsades de pointes: polymorphic VT with QT prolongation

266.2.0.2 必背 — Sudden Cardiac Death (SCD)

• ~ 50% of cardiovascular deaths globally
• ~ 7-9 million deaths/yr
• Causes: ischemia (60-80%) > structural > channelopathy > others

266.2.0.3 必背 — ICD Primary Prevention Indications

• HFrEF EF ≤ 35% + NYHA II-III on optimal Tx ≥ 3 months
• HCM with risk factors (family SCD, syncope, NSVT, LVH ≥ 30 mm, abnormal BP exercise, LGE)
• LQTS with recurrent syncope despite β-blocker
• Brugada + cardiac arrest / syncope
• CPVT + recurrent VT despite β-blocker
• ARVC + high-risk features

266.2.0.4 必背 — Acute Sustained VT Management

• Stable: procainamide IV (PROCAMIO trial), amiodarone IV, lidocaine IV
• Unstable: synchronized cardioversion (100-200 J)
• Refractory: catheter ablation, ECMO bridge

266.2.0.5 必背 — Pulseless VT / VF

• Immediate defibrillation (200 J biphasic)
• CPR + epinephrine + amiodarone 300 mg IV bolus

266.2.0.6 必背 — Torsades de Pointes

• Magnesium 2 g IV first-line
• Correct K + Mg + Ca
• Stop offending drugs
• Isoproterenol or pacing for bradycardia-related
• Defibrillation if sustained

266.2.0.7 必背 — Long QT Drugs (Common)

• Antiarrhythmics (Ia, III)
• Macrolides + FQ
• Antifungals (fluconazole, voriconazole)
• Antipsychotics (haloperidol, clozapine)
• Antidepressants (TCAs, citalopram)
• Methadone, Ondansetron

266.2.0.8 必背 — Channelopathies + Inherited Syndromes

Syndrome	Mutation	Trigger	Treatment
LQT1	KCNQ1	Exercise	β-blocker
LQT2	KCNH2	Startle / loud noise	β-blocker
LQT3	SCN5A	Sleep / rest	β-blocker + mexiletine (some)
Brugada	SCN5A	Fever, drugs (Na+ channel blockers)	ICD + quinidine for storm
CPVT	RYR2	Exercise / catecholamines	β-blocker + flecainide; left cardiac sympathetic denervation for refractory
ARVC	Plakophilin-2, desmoplakin	Exercise	ICD + exercise restriction

266.2.0.9 必背 — Wide-Complex Tachycardia Differential

• Favors VT: older, structural heart disease, AV dissociation, capture/fusion beats, QRS > 140 ms, concordant precordial, NW axis
• Use Brugada algorithm or treat as VT if uncertain

266.2.0.10 必背 — VT vs SVT with Aberrancy

• Treat as VT if uncertain (safety)
• Procainamide IV preferred for stable wide-complex tachycardia
• Synchronized cardioversion if unstable

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