Risk Stratification for Prevention of Sudden Cardiac Death

Abstract

Sudden cardiac death (SCD) is a very prevalent cause of death in the United States. The majority of individuals who experience SCD do not survive the episode. Although there are ongoing efforts to improve resuscitation (ie, training in cardiopulmonary resuscitation, easy access to automatic external defibrillators), the primary modality addressing this public health problem is prevention by identification and treatment of high-risk cohorts. Current screening techniques have focused on identifying patients for primary prevention of ventricular tachyarrhythmias. Primary prevention therapies include medications, such as beta-blockers, statins, and angiotensin-converting enzyme inhibitors, and the implantable cardioverter defibrillator (ICD), whose use is currently focused on only the highest-risk subpopulations. The high-risk groups that are currently screened for consideration of an ICD for either primary or secondary prevention of SCD include those with a variety of cardiomyopathies, those with a history of previous aborted SCD, and those with genetic predispositions. In patients with ischemic cardiomyopathy and nonischemic dilated cardiomyopathy, the primary screening parameter to identify the highest-risk group (which is then subsequently screened for consideration of an ICD) is left ventricular ejection fraction (LVEF). Various other clinical factors and noninvasive test results are often combined with this information, but the optimal way in which this should be done has not been established. The array of noninvasive tests available includes those focusing on depolarization abnormalities, repolarization abnormalities, disturbed autonomic responses, and imaging. Unfortunately, current risk-stratification paradigms do not identify the majority of patients who will experience SCD. The fundamental reason for this is that the risk of SCD is truly lower in those without high-risk features such as depressed LVEF; however, the much larger number of patients with these lower-risk features translates into a larger absolute number of SCDs in this lower-risk group. In order to widen the scope of risk stratification, careful clinical study will be needed to develop appropriate testing strategies that can reliably identify patients at significant risk for ventricular tachyarrhythmias in the broader population.

Short-term vs. long-term heart rate variability in ischemic cardiomyopathy risk stratification

“…However, even today there are still no generally accepted indications identifying HF patients with an increased risk of sudden cardiac death (SCD). Thus, the identification of HF patients at risk still remains an important key issue in clinical decision making (Goldberger et al, 2008; Cygankiewicz et al, 2009; Saha and Goldberger, 2012). In recent decades, the need to risk-stratify patients for targeted therapy has encouraged the search for Holter-based risk predictors of increased risk (Stein and Reddy, 2005).…”

Differences of Ventricular Late Potential between Acute STEMI and NSTEMI Patients

“…Ventricular late potentials reflect the presence of slow conduction within the ventricular myocardium that may serve as a substrate for arrhythmogenesis (5)(6)(7)(8)(9). In the present study, the occurrence rate of ventricular arrhythmia in VLP positive patients is higher than that in VLP negative patients, and VLP is one of the important indicators to predict the ventricular arrhythmia attack in acute myocardial infarction patients.…”

Medical treatment of sudden cardiac death

“…К сожалению, большинство случаев внезапной аритмической смерти происходит не в группе высокого риска. Первичная профилак-тика ВСС у пациентов с промежуточным или низким риском основана на использовании фармакологических вмешательств и изменении образа жизни [6].…”