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Current Cardiology Reports

, 21:106 | Cite as

For Whom the Bell Tolls

Refining Risk Assessment for Sudden Cardiac Death
  • Ivaylo Tonchev
  • David Luria
  • David Orenstein
  • Chaim Lotan
  • Yitschak BitonEmail author
Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
  • 37 Downloads
Part of the following topical collections:
  1. Topical Collection on Invasive Electrophysiology and Pacing

Abstract

Sudden cardiac death is one of the most important causes of death worldwide. Advancements in medical treatment, percutaneous interventions, and device therapy (ICD and CRTD) showed consistent reduction in mortality, mainly in survivors of SCD and in patients with ischemic cardiomyopathy and depressed left ventricular function. Patients with non-ischemic cardiomyopathies, mildly reduced LV function, and channelopathies have increased risk for SCD. Identifying the subgroup of these patients before they experience life-threatening or fatal events is essential to further improve outcomes. In this review, we aimed to summarize the current knowledge for risk stratification and primary prevention, to describe the gaps in evidence, and to discuss future directions for screening and treating patients at risk for SCD.

Purpose of Review

The purpose of this review is to provide a comprehensive description of the etiologies of sudden cardiac death, risk stratification strategies, and to describe the current medical and interventional therapies. We aimed to discuss the current gaps in our knowledge of primary prevention of SCD and to review novel approaches and interventions.

Recent Findings

The incidence of SCD has decreased in the last two decades due to improved pharmacological treatment and ICD implantation in SCD survivors and in patients with reduced left ventricular function and ischemic cardiomyopathy. The efficacy of ICD in patients with non-ischemic cardiomyopathy is challenged by new findings from the DANISH trial. Catheter ablation is new emerging strategy to prevent SCD in patients with scar relater or PVC-triggered ventricular arrhythmias.

Summary

Despite the new treatments, SCD is still a major burden. ICD remains the cornerstone for patients with ischemic cardiomyopathy, whereas appropriate risk stratification of the patients with non-ischemic cardiomyopathy and channelopathies is needed to further improve outcomes. The future of ablation as the treatment and prevention of SCD remains to be studied.

Keywords

Ablation therapy Cardiac resynchronization therapy Implantable cardioverter defibrillator Sudden cardiac death Primary and secondary prevention  Ventricular arrhythmia 

Notes

Acknowledgments

Dr. Yitschak Biton is a Mirowski-Moss Career Development Awardee.

Compliance with Ethical Standards

Conflict of Interest

Ivaylo Tonchev, David Luria, and Yitschak Biton declare that they have no conflict of interest.

David Orenstein reports personal fees from Biotronik, Johnson and Johnson, and Medtronic.

Chaim Lotan reports personal fees from Boehringer-Ingelheim.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ivaylo Tonchev
    • 1
  • David Luria
    • 1
  • David Orenstein
    • 1
  • Chaim Lotan
    • 1
  • Yitschak Biton
    • 1
    • 2
    Email author
  1. 1.Hadassah Medical Center, Heart InstituteHebrew University in Jerusalem Medical SchoolJerusalemIsrael
  2. 2.Heart Research Follow-up Program, Division of CardiologyDepartment of Medicine at the University of Rochester Medical CenterRochesterUSA

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