Sudden cardiac death: A reappraisal.
Sudden cardiac death (SCD) is still among the leading causes of death in women and men, accounting for over 50% of all fatal cardiovascular events in the United States. Two arrhythmia mechanisms of SCD can be distinguished as follows: shockable rhythms (ventricular fibrillation and pulseless ventricular tachycardia) and non-shockable rhythms including asystole or pulseless electrical activity. The overall prognosis of cardiac arrest due to shockable rhythms is significantly better. While the majority of SCDs is attributed to coronary artery disease or other structural heart disease, no obvious cause can be identified in 5% of all events, and those events are labeled as sudden unexplained deaths (SUD). Those unexplained events are typically caused by rare hereditary electrical disorders or arrhythmogenic cardiomyopathies. A systematic approach to the diagnosis of cardiac arrest followed by tailored therapy based on etiology has emerged in the last 10-15 years, with significant changes of medical practice and risk management of cardiac arrest victims. The aim of this review is to summarize our contemporary understanding of SCD/SUD in adults and to discuss current concepts of management and secondary prevention in cardiac arrest victims. A full discussion of the topic of primary prevention of SCD is beyond the scope of this article.
Heart Rhythm Services, University of British Columbia, Vancouver, BC, Canada.
Christian
C
Steinberg
Heart Rhythm Services, University of British Columbia, Vancouver, BC, Canada.
Zachary W M
ZW
Laksman
Heart Rhythm Services, University of British Columbia, Vancouver, BC, Canada. Electronic address: akrahn@mail.ubc.ca.
Andrew D
AD
Krahn
D000465:Algorithms; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D019091:Critical Pathways; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation; D020022:Genetic Predisposition to Disease; D006801:Humans; D010641:Phenotype; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D016896:Treatment Outcome
Cardiac arrest; Cardiopulmonary resuscitation; Genetics; Implantable defibrillator; Sudden cardiac death