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Mechanisms of sudden cardiac death

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Journal of Nuclear Cardiology Aims and scope

Abstract

Sudden cardiac death (SCD) continues to be a major public health problem and is thought to account for almost half of all cardiac deaths. Cardiac arrest and SCD are most commonly due to ventricular arrhythmias. Most patients who suffer cardiac arrest have underlying structural heart disease, with coronary artery disease (CAD) being the most common. In the setting of CAD, ventricular arrhythmias can result due to acute ischemia in the absence of preexisting myocardial scarring or in the presence of established scar from prior infarction without clinically significant ischemia. LV systolic dysfunction is an important predictor of risk for SCD in ischemic heart disease and in most nonischemic disorders, although other factors such as ventricular hypertrophy also play a role. Cardiac arrest and SCD can also occur due to primary electrical disorders in the absence of major structural abnormalities.

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Abbreviations

SCD:

Sudden cardiac death

CAD:

Coronary artery disease

PVC:

Premature ventricular complex

VT:

Ventricular tachycardia

VF:

Ventricular fibrillation

NSVT:

Nonsustained ventricular tachycardia

ARVC:

Arrhythmogenic right ventricular cardiomyopathy

HCM:

Hypertrophic cardiomyopathy

LQTS:

Long QT syndrome

ER:

Early repolarization

References

  1. Myerburg R, Castellanos A. Cardiac arrest and sudden cardiac death. In: Braunwald’s heart disease: A textbook of cardiovascular medicine, chap. 39; 2015. p. 821–60.

  2. Zheng ZJ, Croft JB, Giles WH, Mensah GA. Sudden cardiac death in the United States, 1989 to 1998. Circulation 2001;104:2158–63.

    Article  CAS  PubMed  Google Scholar 

  3. Greene HL. Sudden arrhythmic cardiac death–mechanisms, resuscitation and classification: The Seattle perspective. Am J Cardiol 1990;65:4B–12B.

    Article  CAS  PubMed  Google Scholar 

  4. de Luna AB, Coumel P, Leclercq JF. Ambulatory sudden cardiac death: Mechanisms of production of fatal arrhythmia on the basis of data from 157 cases. Am Heart J 1989;117:151–9.

    Article  Google Scholar 

  5. Antzelevitch C, Burashnikov A. Overview of basic mechanisms of cardiac arrhythmia. Card Electrophysiol Clin 2011;3:23–45.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Myerburg RJ, Interian A Jr, Mitrani RM, Kessler KM, Castellanos A. Frequency of sudden cardiac death and profiles of risk. Am J Cardiol 1997;80:10F–9F.

    Article  CAS  PubMed  Google Scholar 

  7. Liberthson RR, Nagel EL, Hirschman JC, Nussenfeld SR, Blackbourne BD, Davis JH. Pathophysiologic observations in prehospital ventricular fibrillation and sudden cardiac death. Circulation 1974;49:790–8.

    Article  CAS  PubMed  Google Scholar 

  8. Virmani R, Burke AP, Farb A. Sudden cardiac death. Cardiovasc Pathol 2001;10:211–8.

    Article  CAS  PubMed  Google Scholar 

  9. Davies MJ, Thomas A. Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. N Engl J Med 1984;310:1137–40.

    Article  CAS  PubMed  Google Scholar 

  10. Burke AP, Farb A, Malcom GT, Liang Y, Smialek JE, Virmani R. Plaque rupture and sudden death related to exertion in men with coronary artery disease. JAMA 1999;281:921–6.

    Article  CAS  PubMed  Google Scholar 

  11. Gorenek B, Blomstrom Lundqvist C, Brugada Terradellas J, Camm AJ, Hindricks G, Huber K, et al. Cardiac arrhythmias in acute coronary syndromes: Position paper from the joint EHRA, ACCA, and EAPCI task force. Europace 2014;16:1655–73.

    Article  PubMed  Google Scholar 

  12. Huikuri HV, Castellanos A, Myerburg RJ. Sudden death due to cardiac arrhythmias. N Engl J Med 2001;345:1473–82.

    Article  CAS  PubMed  Google Scholar 

  13. Myerburg RJ. Implantable cardioverter-defibrillators after myocardial infarction. N Engl J Med 2008;359:2245–53.

    Article  CAS  PubMed  Google Scholar 

  14. Pogwizd SM, Corr PB. Mechanisms underlying the development of ventricular fibrillation during early myocardial ischemia. Circ Res 1990;66:672–95.

    Article  CAS  PubMed  Google Scholar 

  15. Janse MJ, Wit AL. Electrophysiological mechanisms of ventricular arrhythmias resulting from myocardial ischemia and infarction. Physiol Rev 1989;69:1049–169.

    CAS  PubMed  Google Scholar 

  16. Josephson ME, Horowitz LN, Farshidi A, Kastor JA. Recurrent sustained ventricular tachycardia. 1. Mechanisms. Circulation 1978;57:431–40.

    Article  CAS  PubMed  Google Scholar 

  17. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005;352:225–37.

    Article  CAS  PubMed  Google Scholar 

  18. Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G. A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators. N Engl J Med 1999;341:1882–90.

    Article  CAS  PubMed  Google Scholar 

  19. Gatzoulis KA, Tsiachris D, Arsenos P, Archontakis S, Dilaveris P, Vouliotis A, et al. Prognostic value of programmed ventricular stimulation for sudden death in selected high risk patients with structural heart disease and preserved systolic function. Int J Cardiol 2014;176:1449–51.

    Article  PubMed  Google Scholar 

  20. Maggioni AP, Zuanetti G, Franzosi MG, Rovelli F, Santoro E, Staszewsky L, et al. Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era. GISSI-2 results. Circulation 1993;87:312–22.

    Article  CAS  PubMed  Google Scholar 

  21. Frolkis JP, Pothier CE, Blackstone EH, Lauer MS. Frequent ventricular ectopy after exercise as a predictor of death. N Engl J Med 2003;348:781–90.

    Article  PubMed  Google Scholar 

  22. Goldberger JJ, Cain ME, Hohnloser SH, Kadish AH, Knight BP, Lauer MS, et al. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death. A scientific statement from the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention. J Am Coll Cardiol 2008;52:1179–99.

    Article  PubMed  Google Scholar 

  23. Exner DV, Kavanagh KM, Slawnych MP, Mitchell LB, Ramadan D, Aggarwal SG, et al. Noninvasive risk assessment early after a myocardial infarction the REFINE study. J Am Coll Cardiol 2007;50:2275–84.

    Article  PubMed  Google Scholar 

  24. Corrado D, Thiene G, Cocco P, Frescura C. Non-atherosclerotic coronary artery disease and sudden death in the young. British Heart J 1992;68:601–7.

    Article  CAS  Google Scholar 

  25. Blanck Z, Dhala A, Deshpande S, Sra J, Jazayeri M, Akhtar M. Bundle branch reentrant ventricular tachycardia: Cumulative experience in 48 patients. J Cardiovasc Electrophysiol 1993;4:253–62.

    Article  CAS  PubMed  Google Scholar 

  26. Caceres J, Jazayeri M, McKinnie J, Avitall B, Denker ST, Tchou P, et al. Sustained bundle branch reentry as a mechanism of clinical tachycardia. Circulation 1989;79:256–70.

    Article  CAS  PubMed  Google Scholar 

  27. Zehender M, Faber T, Koscheck U, Meinertz T, Just H. Ventricular tachyarrhythmias, myocardial ischemia, and sudden cardiac death in patients with hypertensive heart disease. Clin Cardiol 1995;18:377–83.

    Article  CAS  PubMed  Google Scholar 

  28. Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P, et al. Classification of the cardiomyopathies: A position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2008;29:270–6.

    Article  PubMed  Google Scholar 

  29. Petretta M, Pirozzi F, Sasso L, Paglia A, Bonaduce D. Review and metaanalysis of the frequency of familial dilated cardiomyopathy. Am J Cardiol 2011;108:1171–6.

    Article  PubMed  Google Scholar 

  30. Kumar S, Stevenson WG, John RM. Arrhythmias in dilated cardiomyopathy. Card Electrophysiol Clin 2015;7:221–33.

    Article  PubMed  Google Scholar 

  31. van Rijsingen IA, Arbustini E, Elliott PM, Mogensen J, Hermans-van Ast JF, van der Kooi AJ, et al. Risk factors for malignant ventricular arrhythmias in lamin a/c mutation carriers a European cohort study. J Am Coll Cardiol 2012;59:493–500.

    Article  PubMed  Google Scholar 

  32. Kjekshus J. Arrhythmias and mortality in congestive heart failure. Am J Cardiol 1990;65:42I–8I.

    Article  CAS  PubMed  Google Scholar 

  33. de Leeuw N, Ruiter DJ, Balk AH, de Jonge N, Melchers WJ, Galama JM. Histopathologic findings in explanted heart tissue from patients with end-stage idiopathic dilated cardiomyopathy. Transpl Int 2001;14:299–306.

    Article  PubMed  Google Scholar 

  34. Sen-Chowdhry S, McKenna WJ. Sudden death from genetic and acquired cardiomyopathies. Circulation 2012;125:1563–76.

    Article  PubMed  Google Scholar 

  35. Nazarian S, Bluemke DA, Lardo AC, Zviman MM, Watkins SP, Dickfeld TL, et al. Magnetic resonance assessment of the substrate for inducible ventricular tachycardia in nonischemic cardiomyopathy. Circulation 2005;112:2821–5.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wu KC, Weiss RG, Thiemann DR, Kitagawa K, Schmidt A, Dalal D, et al. Late gadolinium enhancement by cardiovascular magnetic resonance heralds an adverse prognosis in nonischemic cardiomyopathy. J Am Coll Cardiol 2008;51:2414–21.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Kuruvilla S, Adenaw N, Katwal AB, Lipinski MJ, Kramer CM, Salerno M. Late gadolinium enhancement on cardiac magnetic resonance predicts adverse cardiovascular outcomes in nonischemic cardiomyopathy: A systematic review and meta-analysis. Circ Cardiovasc Imaging 2014;7:250–8.

    Article  PubMed  Google Scholar 

  38. McCrohon JA, Moon JC, Prasad SK, McKenna WJ, Lorenz CH, Coats AJ, et al. Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance. Circulation 2003;108:54–9.

    Article  CAS  PubMed  Google Scholar 

  39. Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, et al. ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 2014;2014(35):2733–79.

    Google Scholar 

  40. Maron BJ. Hypertrophic cardiomyopathy: A systematic review. JAMA 2002;287:1308–20.

    PubMed  Google Scholar 

  41. Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011;124:e783–831.

    Article  PubMed  Google Scholar 

  42. Monserrat L, Elliott PM, Gimeno JR, Sharma S, Penas-Lado M, McKenna WJ. Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy: An independent marker of sudden death risk in young patients. J Am Coll Cardiol 2003;42:873–9.

    Article  PubMed  Google Scholar 

  43. O’Mahony C, Jichi F, Pavlou M, Monserrat L, Anastasakis A, Rapezzi C, et al. A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM risk-SCD). Eur Heart J 2014;35:2010–20.

    Article  PubMed  Google Scholar 

  44. O’Hanlon R, Grasso A, Roughton M, Moon JC, Clark S, Wage R, et al. Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy. J Am Coll Cardiol 2010;56:867–74.

    Article  PubMed  Google Scholar 

  45. Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA, 3rd, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol 2008;51:e1–62.

    Article  PubMed  Google Scholar 

  46. Wolf CM, Berul CI. Inherited conduction system abnormalities–one group of diseases, many genes. J Cardiovasc Electrophysiol 2006;17:446–55.

    Article  PubMed  Google Scholar 

  47. Munger TM, Packer DL, Hammill SC, Feldman BJ, Bailey KR, Ballard DJ, et al. A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989. Circulation 1993;87:866–73.

    Article  CAS  PubMed  Google Scholar 

  48. Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, et al. Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Europace 2013;15:1389–406.

    Article  PubMed  Google Scholar 

  49. Goldenberg I, Moss AJ. Long QT syndrome. J Am Coll Cardiol 2008;51:2291–300.

    Article  PubMed  Google Scholar 

  50. Ackerman MJ, Priori SG, Willems S, Berul C, Brugada R, Calkins H, et al. HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies: This document was developed as a partnership between the Heart Rhythm Society (HRS) and the European Heart Rhythm Association (EHRA). Europace 2011;13:1077–109.

    Article  PubMed  Google Scholar 

  51. Prystowsky EN, Padanilam BJ, Joshi S, Fogel RI. Ventricular arrhythmias in the absence of structural heart disease. J Am Coll Cardiol 2012;59:1733–44.

    Article  PubMed  Google Scholar 

  52. Bjerregaard P, Gussak I. Short QT syndrome: Mechanisms, diagnosis and treatment. Nat Clin Pract Cardiovasc Med 2005;2:84–7.

    Article  PubMed  Google Scholar 

  53. Mizusawa Y, Wilde AA. Brugada syndrome. Circ Arrhythmia Electrophysiol 2012;5:606–16.

    Article  Google Scholar 

  54. Wilde AA, Postema PG, Di Diego JM, Viskin S, Morita H, Fish JM, et al. The pathophysiological mechanism underlying Brugada syndrome: Depolarization versus repolarization. J Mol Cell Cardiol 2010;49:543–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Haissaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, de Roy L, et al. Sudden cardiac arrest associated with early repolarization. N Engl J Med 2008;358:2016–23.

    Article  CAS  PubMed  Google Scholar 

  56. Antzelevitch C, Yan GX. J wave syndromes. Heart Rhythm 2010;7:549–58.

    Article  PubMed  Google Scholar 

  57. Maron BJ, Epstein SE, Roberts WC. Causes of sudden death in competitive athletes. J Am Coll Cardiol 1986;7:204–14.

    Article  CAS  PubMed  Google Scholar 

  58. Januzzi JL and Mann DL, Clinical Assessment in Heart Failure. In Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 23, 473-483

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The authors have no relevant financial conflicts of interest related to this work.

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Authors and Affiliations

  1. Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA

    Samuel K. McElwee MD, Alejandro Velasco MD & Harish Doppalapudi MD

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  1. Samuel K. McElwee MD
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  2. Alejandro Velasco MD
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  3. Harish Doppalapudi MD
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Correspondence to Harish Doppalapudi MD.

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McElwee, S.K., Velasco, A. & Doppalapudi, H. Mechanisms of sudden cardiac death. J. Nucl. Cardiol. 23, 1368–1379 (2016). https://doi.org/10.1007/s12350-016-0600-6

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