Sudden cardiac death: Prevalence, pathogenesis, and prevention

Abstract

Sudden cardiac death (SCD), also known as sudden arrest, is a major health problem worldwide. It is usually defined as an unexpected death from a cardiac cause occurring within a short time in a person with or without preexisting heart disease. The pathogenesis of SCD is complex and multifaceted. A dynamic triggering factor usually interacts with an underlying heart disease, either genetically determined or acquired, and the final outcome is the development of lethal tachyarrhythmias or, less frequently, bradycardia. It has increasingly been highlighted that a reliable clinical and diagnostic approach might be effective to unmask the most important genetic and environmental factors, allowing the construction of a rational personalized medicine framework that can be applied in both the preclinical and clinical settings of SCD. The aim of the present article is to provide a concise overview of prevalence, pathogenesis, clinical presentation, and diagnostic approach to this challenging disorder.

Epidemiology of coronary heart disease and acute coronary syndrome

“…There is a strong relationship between SCD and CHD (92). Clinical and post-mortem studies as well as data from death certificates revealed that 62-85% of patients who suffer out-of-hospital SCD have evidence of prior CHD, 10% have other structural cardiac abnormalities, and 5% have no structural cardiac abnormality (93,94).…”

In vivomodels of cardiac diseases: application to drug development and screening

“…About 25% of cardiovascular-related deaths are due to arrhythmias [20]. Because effectiveness and safety of present therapies for VF or atrial fibrillation (AF) are still incomplete, improved antiarrhythmic agents with more efficiency and less toxicity are needed.…”

Standard Antiarrhythmic Drugs

“…1,2 The most common underlying cause for SCD is ventricular fibrillation (VF). In the past decade, the treatment of arrhythmias has been altered dramatically by the development of nonpharmacologic therapies, such as targeted ablation of arrhythmogenic tissues and implantable cardioverter defibrillators (ICDs), as well as the limited efficacy and proarrhythmic potential of conventional antiarrhythmic drugs.…”