Strategies for the prevention and treatment of sudden cardiac death

Abstract

Cardiovascular diseases account for 40% of all deaths in the West. Sudden cardiac death (SCD) is a major health problem affecting over 300,000 patients annually in the United States alone. Presence of coronary artery disease (CAD), usually in the setting of diminished left ventricular ejection fraction, is still the single major risk factor for SCD. Additionally, acute myocardial ischemia, structural cardiac defects, anomalous coronary arteries, cardiomyopathies, genetic mutations, and ventricular arrhythmias are all attributed to SCD, demonstrating the perplexity of this condition. With the recent advancements in cardiovascular medicine, the incidence of SCD is expected to increase steeply as the prevalence of CAD and heart failure is uprising in general population. Considering SCD, the major challenge confronting contemporary cardiology, multiple strategies for prevention against SCD have been developed. β-blockers have been shown to reduce the risk of SCD, whereas implantable cardioverter-defibrillator devices are found to be effective at terminating the malignant arrhythmias. In recent years, multiple clinical trials were carried out to identify patients who may benefit from preventive intervention, including medical therapy and automatic cardioverter-defibrillator implantations. This review article provides insight into the advanced strategies for the prevention and treatment of SCD based on the data available in medical literature to date.

Figure 1

Brugada syndrome: three types of ST-segment elevation, shown mainly in the precordial leads, type I ECG pattern with pronounced elevation of the J point, a coved-type ST segment, and an inverted T wave in V1–2. Type II ECG pattern with saddleback ST-segment elevation by >1 mm. According to a consensus report.

Figure 2

ESCAPE pathway. Copyright © 2009. Reproduced with permission from Herzog E, Aziz EF, Kukin M, Steinberg JS, Mittal S. Novel pathway for sudden cardiac death prevention. Crit Pathw Cardiol. 2009;8:1–6.