title: Clinical management and prevention of sudden cardiac death.
abstract: Despite the revolutionary advancements in the past 3 decades in the treatment of ventricular tachyarrhythmias with device-based therapy, sudden cardiac death (SCD) remains an enormous public health burden. Survivors of SCD are generally at high risk for recurrent events. The clinical management of such patients requires a multidisciplinary approach from postresuscitative care to a thorough cardiovascular investigation in an attempt to identify the underlying substrate, with potential to eliminate or modify the triggers through catheter ablation and ultimately an implantable cardioverter-defibrillator (ICD) for prompt treatment of recurrences in those at risk. Early recognition of low left ventricular ejection fraction as a strong predictor of death and association of ventricular arrhythmias with sudden death led to significant investigation with antiarrhythmic drugs. The lack of efficacy and the proarrhythmic effects of drugs catalyzed the development and investigation of the ICD through several major clinical trials that proved the efficacy of ICD as a bedrock tool to detect and promptly treat life-threatening arrhythmias. The ICD therapy is routinely used for primary prevention of SCD in patients with cardiomyopathy and high risk inherited arrhythmic conditions and secondary prevention in survivors of sudden cardiac arrest. This compendium will review the clinical management of those surviving SCD and discuss landmark studies of antiarrhythmic drugs, ICD, and cardiac resynchronization therapy in the primary and secondary prevention of SCD.
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD. OYousuf1@jhmi.edu.
authors.forename: Omair
authors.initials: O
authors.lastname: Yousuf
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chrispin
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Gordon F
authors.initials: GF
authors.lastname: Tomaselli
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Berger
mesh_terms: D054058:Acute Coronary Syndrome / Q000517:prevention & control / Q000628:therapy; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D058406:Cardiac Resynchronization Therapy; D016887:Cardiopulmonary Resuscitation; D002317:Cardiovascular Agents / Q000145:classification / Q000627:therapeutic use; D017115:Catheter Ablation; D002986:Clinical Trials as Topic / Q000379:methods; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D019468:Disease Management; D004554:Electric Countershock; D004562:Electrocardiography; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D015337:Multicenter Studies as Topic; D011322:Primary Prevention; D012008:Recurrence; D055502:Secondary Prevention; D017741:Survivors; D013562:Sympathectomy
chemical_list: D002317:Cardiovascular Agents
keywords: cardiac resynchronization therapy; cardiomyopathies; death, sudden, cardiac; defibrillators; defibrillators, implantable; heart arrest; tachycardia, ventricular; ventricular fibrillation