Review Article

Sudden Cardiac Death

Authors: Sheharyar Ali, MD, Eduardo S. Antezano, MD

Abstract

Sudden cardiac death (SCD) due to ventricular tachyarrhythmias is a leading cause of death in the United States. Various etiologies, including ischemic and nonischemic cardiomyopathies, hypertrophic cardiomyopathy, valvular or congenital heart diseases and other less common disorders, may result in SCD. Beta blockers are the only class of medications that have been shown to be beneficial in the primary prevention of SCD. However, recently, aldosterone antagonism early after myocardial infarction has also been shown to significantly reduce the risk of SCD. Multiple trials have elaborated on the potential benefits of implantable cardioverter defibrillators (ICD) in appropriately selected patients. However, there is still some controversy regarding the optimum period for ICD implantation, and its cost-effectiveness. An evidence-based approach to primary and secondary prevention of SCD is presented. Management of out-of-hospital cardiac arrest is briefly discussed.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1.Pinto DS, Josephson ME. Sudden cardiac death. In: Fuster V, ed. Hurst's The Heart. New York, McGraw-Hill, 2004.
 
2.Kannel WB, Cupples LA, D'Agostino RB. Sudden death risk in overt coronary heart disease: the Framingham Study. Am Heart J 1987;113:799–804.
 
3.Uretsky BF, Sheahan RG. Primary prevention of sudden cardiac death in heart failure; will the solution be shocking? J Am Coll Cardiol 1997;30:1589–1597.
 
4.Zipes DP, Wellens HJ. Sudden cardiac death. Circulation 1998;98:2334–2351.
 
5.de Vreede-Swagemarkers JJ, Gorgels AP, Dubois-Arbouz WI, et al. Circumstances and causes of out-of-hospital cardiac arrest in sudden death survivors. Heart 1998;79:356–361.
 
6.Goldstein S, Landis JR, Leighton R, et al. Characteristics of the resuscitated out-of-hospital cardiac arrest victim with coronary heart disease. Circulation 1981;64:977–984.
 
7.Huikuri HV, Castellanos A, Myerburg RJ. Sudden death due to cardiac arrhythmias. N Engl J Med2001;345:1473–1482.
 
8.McKenna W, Behr ER. Hypertrophic cardiomyopathy: management, risk stratification and prevention of sudden death. Heart 2002;87:169–176.
 
9.Antezano ES, Hong M. Sudden cardiac death. J Intensive Care Med 2003;18:313–329.
 
10.Davies MJ. Anatomic features in victims of sudden coronary death: coronary artery pathology.Circulation 1992;85(suppl I)::I-19–I-24.
 
11.Hsia HH, Callans DJ, Marchlinski FE. Characterization of endocardial electrophysiologic substrate in patients with nonischemic cardiomyopathy and monomorphic ventricular tachycardia. Circulation2003;108:704–710.
 
12.Prystowsky EN. Electrophysiologic-electropharmacologic testing in patients with ventricular arrhythmias. Pacing Clin Electrophysiol 1988;11:225–251.
 
13.Yusuf S, Peto R, Lewis J, et al. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 1985;27:335–371.
 
14.Pitt B, White H, Nicolau J, et al. Eplerenone reduced mortality 30 days after randomization following acute myocardial infarction in patients with left ventricular systolic dysfunction and heart failure. J Am Coll Cardiol 2005;46:425–431.
 
15.Echt DS, Liebson PR, Mitchell LB, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo: the Cardiac Arrhythmia Suppression Trial. N Engl J Med 1991;324:781–788.
 
16.Waldo AL, Camm AJ, deRuyter H, et al. Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction: the SWORD Investigators: Survival With Oral d-Sotolol. Lancet 1996;348:7–12.
 
17.Cairns JA, Connolly SJ, Roberts R, et al. Randomized trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarizations: CAMIAT: Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Investigators. Lancet 1997;349:675–682.
 
18.Julian DG, Camm AJ, Frangin G, et al. Randomized trial of effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction: EMIAT: European Myocardial Infarct Amiodarone Trial Investigators. Lancet 1997;349:667–674.
 
19.Nanthakumar K, Epstein AE, Kay NG, et al. Prophylactic implantable cardioverter-defibrillator therapy in patients with left ventricular systolic dysfunction. J Am Coll Cardiol 2004;44:2166–2172.
 
20.Moss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia: Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 1996;335:1933–1940.
 
21.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.
 
22.Buxton AE, Lee KL, Fisher JD, et al. A randomized study of the prevention of sudden death in patients with coronary artery disease: Multicenter Unsustained Tachycardia Trial (MUSTT) Investigators.N Engl J Med 1999;341:1882–1890.
 
23.Bansch D, Antz M, Boczor S, et al. Primary prevention of sudden cardiac death in idiopathic dilated cardiomyopathy: the Cardiomyopathy Trial (CAT). Circulation 2002;105:1453–1458.
 
24.Moss AJ, Zareba W, Hall WJ, et al. Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) Investigators: prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002;346:877–883.
 
25.Strickberger SA, Hummel JD, Bartlett TG, et al. Amiodarone versus implantable cardioverter-defibrillator: randomized trial in patients with nonischemic dilated cardiomyopathy and asymptomatic nonsustained ventricular tachycardia: AMIOVIRT. J Am Coll Cardiol 2003;41:1707–1712.
 
26.Bristow MR, Saxon LA, Boehmer J, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004;350:2140–2150.
 
27.Kadish A, Dyer A, Daubert JP, et al. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med 2004;350:2151–2158.
 
28.Hohnloser SH, Kuck KH, Dorian P, et al. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J Med 2004;351:2481–2488.
 
29.Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005;352:225–237.
 
30.Desai AS, Fang JC, Maisel WH, Baughman KL. Implantable defibrillators for the prevention of mortality in patients with nonischemic cardiomyopathy: a meta-analysis of randomized controlled trials.JAMA 2004;292:2874–2879.
 
31.Pavia S, Wilkoff B. The management of surgical complications of pacemaker and implantable cardioverter-defibrillators. Curr Opin Cardiol 2001;16:66–71.
 
32.Wichter T, Paul M, Wollmann C, et al. Implantable cardioverter/defibrillator therapy in arrhythmogenic right ventricular cardiomyopathy: single-center experience of long-term follow-up and complications in 60 patients. Circulation 2004;109:1503–1508.
 
33.Sweeney MO, Wathen MS, Volosin K, et al. Appropriate and inappropriate ventricular therapies, quality of life and mortality among primary and secondary prevention implantable cardioverter defibrillator patients: results from the Pacing Fast VT REduces Shock ThErapies (Pain FREE Rx II) trial. Circulation2005;111:2898–2905.
 
34.Moss AJ, Greenberg H, Case RB, et al. Long-term clinical course of patients after termination of ventricular tachyarrhythmia by an implanted defibrillator. Circulation 2004;110:3760–3765.
 
35.Miller JM, Hsia HH. Management of the patient with frequent discharges from implantable cardioverter defibrillator devices. J Cardiovasc Electrophysiol 1996;7:278–285.
 
36.Singh JP, Hall WJ, McNitt S, et al. Factors influencing appropriate firing of the implanted defibrillator for ventricular tachycardia/fibrillation: findings from the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II). J Am Coll Cardiol 2005;46:1712–1720.
 
37.Schron EB, Exner DV, Yao Q, et al. Quality of life in the Antiarrhythmics versus Implantable Defibrillators Trial: impact of therapy and influence of adverse symptoms and defibrillator shocks.Circulation 2002;105:589–594.
 
38.Namerow PB, Firth BR, Heywood GM, et al. Quality of life six months after CABG surgery in patients randomized to ICD versus no ICD therapy: findings from the CABG Patch Trial. Pacing Clin Electrophysiol 1999;22:1305–1313.
 
39.Irvine J, Dorian P, Baker B, et al. Quality of life in the Canadian Implantable Defibrillator Study (CIDS). Am Heart J 2002;144:282–289.
 
40.DiMarco JP. Implantable cardioverter-defibrillators. N Engl J Med 2003;349:1836–1847.
 
41.A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias: the Antiarrhythmic versus Implantable Defibrillators (AVID) Investigators. N Engl J Med 1997;337:1576–1583.
 
42.Connolly SJ, Gent M, Roberts RS, et al. Canadian Implantable Defibrillator Study (CIDS): a randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation2000;101:1297–1302.
 
43.Kuck KH, Cappato R, Siebels J, Ruppel R. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest: the Cardiac Arrest Study Hamburg (CASH). Circulation 2000;102:748–754.
 
44.Mushlin AI, Hall WJ, Qwanziger J, et al. The cost-effectiveness of automatic implantable cardiac defibrillators: results from MADIT: Multicenter Automatic Defibrillator Implantation Trial. Circulation1998;97:2129–35.
 
45.Rahimtoola SH. Food for afterthought: reflection from 2 implantable cardioverter defibrillator trials.Arch Intern Med 2004;164:1835–1839.
 
46.Sanders GK, Hlatky MA, Owens DK. Cost-effectiveness of implantable cardioverter-defibrillators. N Engl J Med 2005;353:1471–1480.
 
47.Goldman L, Weinstein MC, Goldman PA, et al. Cost-effectiveness of HMG-CoA reductase inhibition for primary and secondary prevention of coronary artery disease. JAMA 1991;265:1145–1151.
 
48.McClellan MB, Tunis SR. Medicare coverage of ICDs. N Engl J Med 2005;352:222–224.
 
49.Mack MJ. Implantable cardioverter defibrillator (correspondence). N Engl J Med 2005;352:2022–2025.
 
50.Jauhar S, Slotwiner DJ. The economics of ICDs. N Engl J Med 2004;351:2542–2544.
 
51.Weisfeldt ML, Becker LB. Resuscitation after cardiac arrest: a 3-phase time-sensitive model. JAMA2002;288;3035–3038.
 
52.Hong MF, Dorian P. Update on advanced life support and resuscitation techniques. Curr Opin Cardiol2005;20:1–6.