Risk stratification for prevention of sudden cardiac death

Paban Saha, Jeffrey Goldberger

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Opinion statement: Sudden cardiac death (SCD) is a very prevalent cause of death in the United States. The majority of individuals who experience SCD do not survive the episode. Although there are ongoing efforts to improve resuscitation (ie, training in cardiopulmonary resuscitation, easy access to automatic external defibrillators), the primary modality addressing this public health problem is prevention by identification and treatment of high-risk cohorts. Current screening techniques have focused on identifying patients for primary prevention of ventricular tachyarrhythmias. Primary prevention therapies include medications, such as beta-blockers, statins, and angiotensin-converting enzyme inhibitors, and the implantable cardioverter defibrillator (ICD), whose use is currently focused on only the highest-risk subpopulations. The high-risk groups that are currently screened for consideration of an ICD for either primary or secondary prevention of SCD include those with a variety of cardiomyopathies, those with a history of previous aborted SCD, and those with genetic predispositions. In patients with ischemic cardiomyopathy and nonischemic dilated cardiomyopathy, the primary screening parameter to identify the highest-risk group (which is then subsequently screened for consideration of an ICD) is left ventricular ejection fraction (LVEF). Various other clinical factors and noninvasive test results are often combined with this information, but the optimal way in which this should be done has not been established. The array of noninvasive tests available includes those focusing on depolarization abnormalities, repolarization abnormalities, disturbed autonomic responses, and imaging. Unfortunately, current risk-stratification paradigms do not identify the majority of patients who will experience SCD. The fundamental reason for this is that the risk of SCD is truly lower in those without high-risk features such as depressed LVEF; however, the much larger number of patients with these lower-risk features translates into a larger absolute number of SCDs in this lower-risk group. In order to widen the scope of risk stratification, careful clinical study will be needed to develop appropriate testing strategies that can reliably identify patients at significant risk for ventricular tachyarrhythmias in the broader population.

Original languageEnglish (US)
Pages (from-to)81-90
Number of pages10
JournalCurrent Treatment Options in Cardiovascular Medicine
Volume14
Issue number1
DOIs
StatePublished - Feb 1 2012
Externally publishedYes

Fingerprint

Sudden Cardiac Death
Implantable Defibrillators
Primary Prevention
Cardiomyopathies
Tachycardia
Stroke Volume
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Defibrillators
Cardiopulmonary Resuscitation
Dilated Cardiomyopathy
Genetic Predisposition to Disease
Secondary Prevention
Angiotensin-Converting Enzyme Inhibitors
Resuscitation
Cause of Death
Public Health

Keywords

  • ICD
  • Prevention
  • Risk stratification
  • Sudden cardiac death
  • VF
  • VT

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Risk stratification for prevention of sudden cardiac death. / Saha, Paban; Goldberger, Jeffrey.

In: Current Treatment Options in Cardiovascular Medicine, Vol. 14, No. 1, 01.02.2012, p. 81-90.

Research output: Contribution to journalArticle

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