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Clinical Management of Ventricular Arrhythmias

Course #90374 - $90 -

15
  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.
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Overview

This course will begin with a discussion of the electrophysiology of ventricular arrhythmias, including premature ventricular contractions, ventricular tachycardia, and ventricular fibrillation. Related pathophysiology, including the impact of ventricular arrhythmias on cardiac output, signs and symptoms, and underlying diseases will be discussed. Guidelines for the immediate management of life-threatening ventricular arrhythmias in the hospital and community setting will be explained with emphasis on the use of the automated external defibrillator (AED) and current advanced cardiac life support (ACLS) guidelines. Current therapies for the long-term management of ventricular arrhythmias, including ICD therapy, the use of antiarrhythmic medications, the role of electrophysiology, the use of radiofrequency ablation, and surgical procedures designed to eliminate ventricular arrhythmias will be presented. The module will conclude with simulated case studies.

Education Category: Medical / Surgical
Release Date: 01/01/2024
Expiration Date: 12/31/2026

Table of Contents

  1. INTRODUCTION
  2. BASIC CONCEPTS: A REVIEW
  3. PREMATURE VENTRICULAR CONTRACTIONS
  4. VENTRICULAR TACHYCARDIAS
  5. VENTRICULAR FIBRILLATION
  6. OVERVIEW: AMERICAN HEART ASSOCIATION "CHAIN OF SURVIVAL"
  7. EMERGENCY MANAGEMENT OF VENTRICULAR ARRHYTHMIAS
  8. LONG-TERM MANAGEMENT OF VENTRICULAR ARRHYTHMIAS
  9. MANAGEMENT OF PVCs AND NONSUSTAINED VT
  10. IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR THERAPY
  11. MANAGING WITH AN ICD AT HOME
  12. LONG-TERM MANAGEMENT OF ICD FUNCTION
  13. ANTIARRHYTHMIC DRUG THERAPY
  14. ABLATION OF VENTRICULAR TACHYCARDIA
  15. OPTIMIZATION OF UNDERLYING DISEASE MANAGEMENT
  16. SURGICAL RECONSTRUCTION
  17. TRENDS AND ISSUES IN THE MANAGEMENT OF VENTRICULAR ARRHYTHMIAS
  18. SIMULATED CASE STUDIES
  19. CONCLUSION
  20. GLOSSARY OF TERMS
  21. RESOURCES
  22. Works Cited
  23. Evidence-Based Practice Recommendations Citations

Audience

This course is designed for physicians, physician assistants, nurse practitioners, and nurses seeking to enhance their knowledge of ventricular arrhythmias. The course is of particular importance for clinicians in the primary care and emergency settings.

Accreditations & Approvals

In support of improving patient care, TRC Healthcare/NetCE is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. NetCE is approved to offer continuing education through the Florida Board of Nursing Home Administrators, Provider #50-2405. NetCE is accredited by the International Accreditors for Continuing Education and Training (IACET). NetCE complies with the ANSI/IACET Standard, which is recognized internationally as a standard of excellence in instructional practices. As a result of this accreditation, NetCE is authorized to issue the IACET CEU.

Designations of Credit

This activity was planned by and for the healthcare team, and learners will receive 15 Interprofessional Continuing Education (IPCE) credit(s) for learning and change. NetCE designates this enduring material for a maximum of 15 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. NetCE designates this continuing education activity for 15 ANCC contact hour(s). NetCE designates this continuing education activity for 5 pharmacology hour(s) for physician assistants. NetCE designates this continuing education activity for 5 pharmacotherapeutic/pharmacology contact hour(s). NetCE designates this continuing education activity for 18 hours for Alabama nurses. Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 15 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Completion of this course constitutes permission to share the completion data with ACCME. Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn credit toward the CME and/or Self-Assessment requirements of the American Board of Surgery's Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit. This activity has been approved for the American Board of Anesthesiology’s® (ABA) requirements for Part II: Lifelong Learning and Self-Assessment of the American Board of Anesthesiology’s (ABA) redesigned Maintenance of Certification in Anesthesiology Program® (MOCA®), known as MOCA 2.0®. Please consult the ABA website, www.theABA.org, for a list of all MOCA 2.0 requirements. Maintenance of Certification in Anesthesiology Program® and MOCA® are registered certification marks of the American Board of Anesthesiology®. MOCA 2.0® is a trademark of the American Board of Anesthesiology®. Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME's "CME in Support of MOC" program in Section 3 of the Royal College's MOC Program. This home study course is approved by the Florida Board of Nursing Home Administrators for 15 credit hour(s). NetCE is authorized by IACET to offer 1.5 CEU(s) for this program. AACN Synergy CERP Category A.

Individual State Nursing Approvals

In addition to states that accept ANCC, NetCE is approved as a provider of continuing education in nursing by: Alabama, Provider #ABNP0353 (valid through July 29, 2025); Arkansas, Provider #50-2405; California, BRN Provider #CEP9784; California, LVN Provider #V10662; California, PT Provider #V10842; District of Columbia, Provider #50-2405; Florida, Provider #50-2405; Georgia, Provider #50-2405; Kentucky, Provider #7-0054 through 12/31/2025; South Carolina, Provider #50-2405; West Virginia RN and APRN, Provider #50-2405.

Special Approvals

This activity is designed to comply with the requirements of California Assembly Bill 1195, Cultural and Linguistic Competency.

Course Objective

The purpose of this course is to provide physicians, nurses, and other healthcare professionals with up-to-date knowledge of risk factors for development of ventricular arrhythmias, recommended therapies for the immediate and long-term management of arrhythmias, and indications of complications or side effects of therapy necessary to facilitate effective patient management, early identification of problems, and appropriate patient and family education.

Learning Objectives

Upon completion of this course, you should be able to:

  1. Define basic concepts of normal cardiac conduction, including cellular events, and normal electrocardiogram (ECG) waveform.
  2. Identify premature ventricular complexes (PVCs), including electrophysiologic characteristics, patterns of occurrence, related symptoms and common precipitating causes.
  3. Describe monomorphic ventricular tachycardia (VT), including electrophysiologic characteristics, impact on physiologic functioning, and underlying pathophysiology.
  4. Identify polymorphic VT, including electrophysiologic characteristics, impact on physiologic functioning, and underlying pathophysiology.
  5. Describe ventricular fibrillation, including electro­physio-logic characteristics, impact on physiologic functioning, and underlying pathophysiology.
  6. List key points in the American Heart Association's Chain of Survival, including the use of automated external defibrillators (AEDs).
  7. Summarize key points in the emergency management of life-threatening ventricular arrhythmias for patients, as recommended by Advanced Cardiovascular Life Support (ACLS) guidelines.
  8. Outline the assessment, diagnosis, and risk stratification process for patients who have, or are deemed to be at risk for, ventricular arrhythmias.
  9. Describe the management of PVCs and nonsustained VT in persons with and without heart disease.
  10. State major indications for implantable cardioverter-defibrillators (ICDs) and outline the basic components, functions, therapy options, and implantation procedure for current generation ICDs.
  11. Discuss basic discharge education, home safety measures, psychosocial considerations, and medical follow-up for a person post-ICD implantation.
  12. Evaluate problems that may occur with ICD functioning, including ICD storm, delivery of inappropriate shocks, and failure to deliver therapy.
  13. Describe the use of antiarrhythmic medications in the long-term management of ventricular arrhythmias.
  14. Describe additional therapies that may be used in the management of ventricular arrhythmias, including the optimization of medical therapy for underlying heart disease and the use of ventricular reconstruction surgery.
  15. Analyze current trends and issues in the management of persons who have, or are at risk for, ventricular arrhythmias.
  16. Using simulated clinical data, discuss the clinical management of a person with ischemic cardiomyopathy and nonsustained VT, and the clinical management of a person who experiences multiple ICD shocks.

Faculty

Karen Majorowicz, RN, is currently employed in the Cardiac Intermediate Care Unit at Shands Healthcare at the University of Florida, Gainesville. She received her Master's in Medical-Surgical Nursing in 1978 from the University of Maryland. Karen has created numerous instructional manuals on Medicare and has conducted educational programs on cardiovascular assessment.

Faculty Disclosure

Contributing faculty, Karen Majorowicz, RN, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

Division Planners

John M. Leonard, MD

Mary Franks, MSN, APRN, FNP-C

Division Planners Disclosure

The division planners have disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

Director of Development and Academic Affairs

Sarah Campbell

Director Disclosure Statement

The Director of Development and Academic Affairs has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

About the Sponsor

The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare.

Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice.

Disclosure Statement

It is the policy of NetCE not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.

Technical Requirements

Supported browsers for Windows include Microsoft Internet Explorer 9.0 and up, Mozilla Firefox 3.0 and up, Opera 9.0 and up, and Google Chrome. Supported browsers for Macintosh include Safari, Mozilla Firefox 3.0 and up, Opera 9.0 and up, and Google Chrome. Other operating systems and browsers that include complete implementations of ECMAScript edition 3 and CSS 2.0 may work, but are not supported. Supported browsers must utilize the TLS encryption protocol v1.1 or v1.2 in order to connect to pages that require a secured HTTPS connection. TLS v1.0 is not supported.

Implicit Bias in Health Care

The role of implicit biases on healthcare outcomes has become a concern, as there is some evidence that implicit biases contribute to health disparities, professionals' attitudes toward and interactions with patients, quality of care, diagnoses, and treatment decisions. This may produce differences in help-seeking, diagnoses, and ultimately treatments and interventions. Implicit biases may also unwittingly produce professional behaviors, attitudes, and interactions that reduce patients' trust and comfort with their provider, leading to earlier termination of visits and/or reduced adherence and follow-up. Disadvantaged groups are marginalized in the healthcare system and vulnerable on multiple levels; health professionals' implicit biases can further exacerbate these existing disadvantages.

Interventions or strategies designed to reduce implicit bias may be categorized as change-based or control-based. Change-based interventions focus on reducing or changing cognitive associations underlying implicit biases. These interventions might include challenging stereotypes. Conversely, control-based interventions involve reducing the effects of the implicit bias on the individual's behaviors. These strategies include increasing awareness of biased thoughts and responses. The two types of interventions are not mutually exclusive and may be used synergistically.