Risk Stratification of Sudden Cardiac Death After Acute Myocardial Infarction

Abstract

ABSTRACT. Despite advances in the diagnosis and treatment of acute coronary syndromes and an overall improvement in outcomes, mortality after myocardial infarction (MI) remains high. Sudden death, which is most frequently due to ventricular tachycardia or ventricular fibrillationsignificantly reduce the risk of arrhythmic sudden death when used in appropriate patients following MI. As ICD implantation is costly and associated with risks, a great deal of effort has been made to prospectively identify the subgroup of patients with MI who are at highest risk of arrhythmic sudden death, and whom therefore would likely derive the most benefit from ICD implantation. This manuscript will review the epidemiology of sudden death and ventricular arrhythmias post-MI, and will discuss the current state of risk stratification for and the prevention of sudden death in this population. Etiology and pathogenesis of sudden death post-myocardial infarctionUnderstanding the mechanisms of sudden death after MI is critical to understanding risk stratification tools and the utility of therapies such as the ICD in reducing the

From evidence-based medicine to digital twin technology for predicting ventricular tachycardia in ischaemic cardiomyopathy

“…There are three arrhythmogenic mechanisms: abnormal automaticity (accelerated, ectopic generation of an action potential by myocardial tissue), triggered activity (spontaneous depolarization occurring during or after repolarization) and re-entry [14]. In the ischaemic cardiomyopathy population, where patients have an oxygen deficit of the heart caused by reduced myocardial perfusion (such as MI) with related cardiac dysfunction, re-entry is the most important mechanism causing VT. To systematize the pathophysiology underlying re-entry, Philippe Coumel introduced the widely accepted triangle consisting of the substrate, the trigger and the modulator (figure 2).…”

“…Further, an introduction to data-driven models and mechanistic models are given, including some state-of-the-art examples for VT and VT-ablation prediction ( § §3 and 4, respectively). Not all studies will be discussed in detail, since there is an abundance of excellent clinical reviews [13,14], cardiac AI reviews [15][16][17][18][19] and cardiac mechanistic model reviews [20][21][22][23] available. The second objective builds on the insights obtained by the exploration of the existing literature and aims to provide our perspective on the open challenges and gains of Approach 4, the digital twin concept, and how it is envisioned to move VT prediction from population based to a patient-specific approach ( §5).…”

Sudden cardiac death: epidemiology, pathogenesis and management

“…Following MI, the major causes of SCD are tachyarrhythmias, re-infarction, and myocardial rupture. Nonetheless, the risk for SCD declines as time passes [31].…”

Risk Factors Associated with the Incidence of Ventricular Arrhythmias Complicating Acute Myocardial Infarction and Prognosis Analysis

“…AMI is accompanied by increased serum myocardial enzyme activity and progressive changes in an electrocardiogram, which can be complicated by arrhythmia, shock, or heart failure, and can often be life-threatening [2]. Sudden cardiac death results from sustained ventricular arrhythmia (VTA) and ventricular fibrillation complicating AMI in approximately 20-50% of cases [3]. VTA is a serious sequela of ventricular remodeling after MI.…”