Skip to main content

Advertisement

SpringerLink
Log in

Sudden cardiac death

  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

  • Great strides have been made in the approach to the management of sudden cardiac death. Patients who have been successfully resuscitated from an episode of sudden cardiac death are at high risk of recurrence. Much larger groups of patients who have not had episodes of sudden cardiac death are also at substantial risk for this event, however. Because the survival rates associated with out-of-hospital cardiac arrest are dismal, these high-risk populations must be targeted for prophylaxis.

  • Beta-blockers have been shown to be an effective pharmacologic therapy in patients who have had myocardial infarction and, most recently, in patients with congestive heart failure. When possible, these agents should be used in these populations

  • No class I or class III antiarrhythmic drugs, with the possible exception of amiodarone, have been shown to have efficacy as prophylactic agents for the reduction of mortality in these populations.

  • In patients who have hemodynamically significant sustained ventricular tachyarrhythmias or an aborted episode of sudden cardiac death, the current therapy of choice is an implantable cardioverter-defibrillator (ICD).

  • For prophylaxis of sudden cardiac death in patients who have not had a previous event, several approaches may be considered. Currently, the best therapeutic approach for prophylaxis of sudden cardiac death seems to be the ICD; however, use of this device can be justified only in patients at substantial risk of sudden cardiac death

  • Defining the high-risk populations that will benefit from ICDs is critical in managing the problem of sudden cardiac death.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Baum R, Alvarez H, Cobb L: Survival after resuscitation from out-of-hospital ventricular fibrillation. Circulation 1974, 50:1231–1235.

    PubMed  CAS  Google Scholar 

  2. Cobb L, Baum R, Alvarez H, Schaffer W: Resuscitation from out-of-hospital ventricular fibrillation: 4 years follow-up. Circulation 1975, 52:III223-III235.

    PubMed  CAS  Google Scholar 

  3. Wiesfeld A, Crijns H, Hillege H, et al.: The clinical significance of coronary anatomy in post-infarct patients with late sustained ventricular or ventricular fibrillation. Eur Heart J 1995, 16:818–824.

    PubMed  CAS  Google Scholar 

  4. Lessmeier T, Lehmann M, Steinman R, et al.: Implantable cardioverter-defibrillator therapy in 300 patients with coronary artery disease presenting exclusively with ventricular fibrillation. Am Heart J 1994, 128:211–218.

    Article  PubMed  CAS  Google Scholar 

  5. Multicenter Postinfarction Research Group: Risk stratification and survival after myocardial infarction. N Engl J Med 1983, 309:331–336.

    Article  Google Scholar 

  6. Maggioni A, Zuanetti G, Franzosi M, et al.: Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era. Circulation 1993, 87:312–322.

    PubMed  CAS  Google Scholar 

  7. Doval H, Nul D, Grancelli H, et al.: Randomised trial of low-dose amiodarone in severe congestive heart failure. Lancet 1994, 344:493–498.

    Article  PubMed  CAS  Google Scholar 

  8. Cardiac Arrhythmia Suppression Trial Investigators (CAST): Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 1989, 321:406–412.

    Article  Google Scholar 

  9. Teo K, Yusuf S, Furberg C: Effects of prophylactic antiarrhythmic drug therapy in acute myocardial infarction. An overview of results from randomized controlled trials. JAMA 1993, 270:1589–1595.

    Article  PubMed  CAS  Google Scholar 

  10. Packer M, Bristow M, Cohn J, et al.: The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 1996, 334:1349–1355.

    Article  PubMed  CAS  Google Scholar 

  11. Steinbeck G, Andresen D, Bach P, et al.: A comparison of electrophysiologically guided antiarrhythmic drug therapy with beta-blocker therapy in patients with symptomatic, sustained ventricular tachyarrhythmias. N Engl J Med 1992, 327:987–992.

    Article  PubMed  CAS  Google Scholar 

  12. Barron H, Viskin S, Lundstrom R, et al.: Beta-blocker dosages and mortality after myocardial infarction: data from a large health maintenance organization. Arch Intern Med 1998, 158:449–453.

    Article  PubMed  CAS  Google Scholar 

  13. Mason J: A comparison of electrophysiologic testing with Holter monitoring to predict antiarrhythmicdrug efficacy for ventricular tachyarrhythmias. N Engl J Med 1993, 329:445–451.

    Article  PubMed  CAS  Google Scholar 

  14. Mason J: A comparison of seven antiarrhythmic drugs in patients with ventricular tachyarrhythmias. N Engl J Med 1993, 329:452–458.

    Article  PubMed  CAS  Google Scholar 

  15. Reiffel J, Reiter M, Freedman R, et al.: Influence of Holter monitor and electrophysiologic study methods and efficacy criteria on the outcome of patients with ventricular tachycardia and ventricular fibrillation in the ESVEM trial. Prog Cardiovasc Dis 1996, 5:359–370.

    Article  Google Scholar 

  16. Mitchell L, Duff H, Manyari D, Wyse D: A randomized clinical trial of the noninvasive and invasive approaches to drug therapy of ventricular tachycardia. N Engl J Med 1987, 317:1681–1687.

    Article  PubMed  CAS  Google Scholar 

  17. Wilber D, Garan H, Finkelstein D, et al.: Use of electrophysiologic testing in the prediction of long-term outcome. N Engl J Med 1988, 318:19–24.

    Article  PubMed  CAS  Google Scholar 

  18. Mitchell B, Shelson R, Gillis A, et al.: Definition of predicted effective antiarrhythmic drug therapy for ventricular tachyarrhythmias by the electrophysiologic study approach: randomized comparison of patient response criteria. J Am Coll Cardiol 1997, 30:1346–1353.

    Article  PubMed  CAS  Google Scholar 

  19. Haverkamp W, Rubio-Martinez A, Heif A, et al.: Efficacy and safety of d,l-sotalol in patients with ventricular tachycardia and in survivors of cardiac arrest. J Am Coll Cardiol 1997, 30:487–495.

    Article  PubMed  CAS  Google Scholar 

  20. Bocker D, Haverkamp W, Block M, et al.: Comparison of d,l-sotalol and implantable defibrillators for treatment of sustained ventricular tachycardia or fibrillation in patients with coronary artery disease. Circulation 1996, 95:151–157.

    Google Scholar 

  21. Waldo A, Camm A, deRuyter H, et al.: Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. Lancet 1996, 348:7–12.

    Article  PubMed  CAS  Google Scholar 

  22. Julian D, Camm A, Frangin G, et al.: Randomised trial of effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction: EMIAT. Lancet 1997, 349:667–674. This multicenter trial, along with that of Cairns et al. [23], showed that prophylactic amiodarone given to patients wit low ejection fractions or frequent ventricular ectopy after myocardial infarction has no effect on total mortality, even though it reduces the combined end points of resuscitated cardiac arrest and arrhythmia mortality.

    Article  PubMed  CAS  Google Scholar 

  23. Cairns J, Connolly S, Roberts R, Gent M: Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. Lancet 1997, 349:675–682. This multicenter trial, together with that of Julian et al. [22], showed that prophylactic amiodarone given to patients wit low ejection fractions or frequent ventricular ectopy after myocardial infarction has no effect on total mortality, even though it reduces the combined end points of resuscitated cardiac arrest and arrhythmia mortality.

    Article  PubMed  CAS  Google Scholar 

  24. Connolly S, Cairns J, Gent M, et al.: Effect of prophylactic amiodarone on mortality after acute myocardial infarction and in congestive heart failure: meta-analysis of individual data from 6500 patients in randomized trials. Lancet 1997, 350:1417–1424.

    Article  Google Scholar 

  25. Wilber D, Olshansky B, Moran J, Scanlon P: Electrophysiological testing and non-sustained ventricular tachycardia: use and limitations in patients with coronary artery disease and impaired ventricular function. Circulation 1990, 82:350–358.

    PubMed  CAS  Google Scholar 

  26. Gomes J, Hariman R, Kang P: Programmed electrical stimulation in patients with high-grade ventricular ectopy: electrophysiologic findings and prognosis for survival. Circulation 1984, 70:43–51.

    PubMed  CAS  Google Scholar 

  27. Buxton A, Marchlinski F, Flores B, et al.: Non-sustained ventricular tachycardia in patients with coronary artery disease: role of electrophysiologic study. Circulation 1987, 75:1178–1185.

    PubMed  CAS  Google Scholar 

  28. Klein R, Machell C: Use of electrophysiologic testing in patients with nonsustained ventricular tachycardia: prognostic and therapeutic implications. J Am Coll Cardiol 1989, 14:155–161.

    Article  PubMed  CAS  Google Scholar 

  29. Dusman R, Stanton M, Miles W, et al.: Clinical features of amiodarone-induced pulmonary toxicity. Circulation 1990, 82:51–59.

    PubMed  CAS  Google Scholar 

  30. Antiarrhythmics Versus Implantable Defibrillators Investigators: A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med 1997, 337:1576–1583. This multicenter study compared antiarrhythmic drug therapy with implantable cardioverter-defibrillator (ICD) implantation for the treatment of patients with hemodynamically significant ventricular tachycardia or ventricular fibrillation. It showed that ICD therapy is superior to amiodarone therapy.

    Article  Google Scholar 

  31. Horowitz L, Greenspan A, Spielman S, et al.: Usefulness of electrophysiologic testing in evaluation of amiodarone therapy for sustained ventricular tachyarrhythmias associated with coronary heart disease. Am J Cardiol 1985, 55:367–371.

    Article  PubMed  CAS  Google Scholar 

  32. Weinberg B, Miles W, Klein L, et al.: Five-year followup of 589 patients treated with amiodarone. Am Heart J 1993, 125:109–120.

    Article  PubMed  CAS  Google Scholar 

  33. Herre J, Sauve M, Malone P, et al.: Long-term results of amiodarone therapy in patients with recurrent sustained ventricular tachycardia or ventricular fibrillation. J Am Coll Cardiol 1989, 13:442–449.

    Article  PubMed  CAS  Google Scholar 

  34. Kuhlkamp V, Mewis C, Mermi J, et al.: Suppression of sustained ventricular tachyarrhythmias: a comparison of d,l-sotalol with no antiarrhythmic drug treatment. J Am Coll Cardiol 1999, 33:46–52.

    Article  PubMed  CAS  Google Scholar 

  35. Zipes D, Roberts D: Results of the international study of the implantable pacemaker cardioverterdefibrillator. Circulation 1995, 92:59–65.

    PubMed  CAS  Google Scholar 

  36. Wever E, Hauer R, VanCapelle F, et al.: Randomized study of implantable defibrillator as first-choice therapy versus conventional strategy in postinfarct sudden death survivors. Circulation 1995, 91:2195–2203.

    PubMed  CAS  Google Scholar 

  37. Moss A, Hall W, Cannom D, et al.: Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med 1996, 335:1933–1940. This multicenter trial was the first to evaluate the prophylactic use of implantable cardoverter-defibrillators (ICDs) in a highrisk population. Patients with ejection fractions of less than 36%, nonsustained ventricular tachycardia, and inducible ventricular tachycardia that was not suppressed by procainamide were randomly assigned to receive an ICD or another therapy directed by their physician. The group receiving an ICD had a substantially lower mortality rate.

    Article  PubMed  CAS  Google Scholar 

  38. 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.

    Article  PubMed  Google Scholar 

  39. Mushlin A, Hall W, Zwanziger J, et al.: The costeffectiveness of autonomic implantable cardiac defibrillators: results from MADIT. Circulation 1998, 97:2129–2135.

    PubMed  CAS  Google Scholar 

  40. Kupersmith J, Hogan A, Guerrero P, et al.: Evaluating and improving the cost-effectiveness of the implantable cardioverter-defibrillator. Am Heart J 1995, 130:507–515.

    Article  PubMed  CAS  Google Scholar 

  41. Wever E, Hauer R, Schrijvers G, et al.: Cost-effectiveness of implantable defibrillator as first-choice therapy versus electrophysiologically guided, tiered strategy in postinfarct sudden death survivors. Circulation 1996, 93:489–496.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Northwestern Memorial Hospital, 250 East Superior Street, Wesley Pavilion, Suite #520, 60611, Chicago, IL, USA

    Jeffrey J. Goldberger MD

Authors
  1. Jeffrey J. Goldberger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goldberger, J.J. Sudden cardiac death. Curr Treat Options Cardio Med 1, 127–135 (1999). https://doi.org/10.1007/s11936-999-0016-6

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11936-999-0016-6

Keywords

Search

Navigation