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Sudden Death in Heart Failure: Risk Stratification and Treatment Strategies

  • Chapter
Perioperative Critical Care Cardiology

Part of the book series: Topics in Anaesthesia and Critical Care ((TIACC))

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Abstract

Attempting a careful evaluation of the incidence of sudden death (SD) in congestive heart failure is inevitably a complex and imprecise task. In particular, this is due to the difficulties in defining and understanding the baseline mechanisms underlying SD. “Sudden” death is commonly regarded as a synonym of “cardiac arrest due to ventricular fibrillation,” which is in turn considered to be a merely arrhythmic phenomenon occurring during apparent wellbeing, and without any precipitating cause other than an extrasystole or a sustained ventricular tachycardia. Cardiac arrest may also be the terminal event during refractory pulmonary edema and/or cardiogenic shock in a patient with end-stage heart failure, a pulmonary embolism in a patient with severe biventricular dysfunction, bradyarrhythmia due to advanced atrioventricular (AV) block, electrical asystole, ventricular fibrillation secondary to myocardial ischemia or infarction, or secondary to a noncardiac event such as a cerebro vascular accident or a ruptured aortic aneurysm. Pratt et al.[1] analyzed a population of 834 patients with an automatic implantable cardioverter defibrillator (ICD) implanted for ventricular tachycardia or sustained ventricular tachycardia. During follow-up 109 patients died (17 died “suddenly”). Autopsy findings revealed a nonarrhythmic cause (pulmonary embolism, ruptured aortic aneurysm, stroke, acute myocardial infarction) in 7/17 patients. Postmortem analysis of the ICD memory revealed ventricular tachyarrhythmias preceding death in only 7/17 patients.

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  1. Cardiovascular Department, “Ospedali Riuniti” and University of Trieste, Trieste, Italy

    M. Zecchin, G. Vitrella & G. Sinagra

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Zecchin, M., Vitrella, G., Sinagra, G. (2007). Sudden Death in Heart Failure: Risk Stratification and Treatment Strategies. In: Perioperative Critical Care Cardiology. Topics in Anaesthesia and Critical Care. Springer, Milano. https://doi.org/10.1007/978-88-470-0558-7_1

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