Impact of Nontraditional Antiarrhythmic Drugs on Sudden Cardiac Death

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

“…The spectrum of noninvasive methods reviewed in the sections that follow were developed to detect the presence of factors known to serve as substrate or triggers of VT/VF or abnormalities in ventricular conduction and repolarization that are critical to reentry. The specific techniques discussed are those that detect (1) slowed conduction (QRS duration, signal-averaged electrocardiogram [SAECG]), (2) heterogeneities in ventricular repolarization (QT interval, QT dispersion, T-wave alternans), (3) imbalance in autonomic tone (heart rate variability [HRV], heart rate turbulence, heart rate recovery after exercise, baroreceptor sensitivity), (4) extent of myocardial damage and scar formation (left ventricular ejection fraction [LVEF], 6-minute walk), and (5) ventricular ectopy (longterm ambulatory monitoring). Although many studies have explored the value of these techniques, the precise relationship between the presence of these abnormalities, some of which are persistently present, and the unpredictable occurrence of VT/VF has not been elucidated.…”

“…156 Some medical therapies for congestive heart failure have been shown to reduce both progressive heart failure and SCD due to cardiovascular causes. 2,157 ICD trials have found that heart failure symptoms are associated with defibrillator therapies. A recent study, the Triggers Of Ventricular Arrhythmias (TOVA), identified NYHA functional class III as the strongest independent predictor of appropriate ICD therapy.…”

“…Despite all of these advances, however, overall mortality from a cardiac arrest remains high, which under-scores the need for risk stratification techniques to identify patients at high risk for these events and effective interventions that can prevent or abort these events. Although risk stratification techniques have been studied for decades, their current relevance is enhanced by the availability of medical therapies 2 and the implantable cardioverter defibrillator (ICD), which have been shown to reduce both total and SCD mortality in selected high-risk patients.…”

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

“…Manifestations of neurohormonal activation, such as hyponatremia and increased plasma norepinephrine, renin, and natriuretic peptide levels, have been found to be predictive of mortality (156). Some medical therapies for congestive heart failure have been shown to reduce both progressive heart failure and SCD due to cardiovascular causes (2,157).…”

“…Despite all of these advances, however, overall mortality from a cardiac arrest remains high, which underscores the need for risk stratification techniques to identify patients at high risk for these events and effective interventions that can prevent or abort these events. Although risk stratification techniques have been studied for decades, their current relevance is enhanced by the availability of medical therapies (2) and the implantable cardioverter defibrillator (ICD), which have been shown to reduce both total and SCD mortality in selected high-risk patients.…”