Sudden Cardiac Death 

  • Author: Ali A Sovari, MD, FACP; Chief Editor: Jeffrey N Rottman, MD   more...
 
Updated: Dec 5, 2011
 

Background

Sudden cardiac death (SCD) is an unexpected death due to cardiac causes occurring in a short time period (generally within 1 h of symptom onset) in a person with known or unknown cardiac disease. Most cases of SCD are related to cardiac arrhythmias. Approximately half of all cardiac deaths can be classified as SCDs. SCD represents the first expression of cardiac disease in many individuals presenting with out-of-hospital cardiac arrest. This article explores the epidemiology, pathophysiology, diagnostic approach, and treatment of patients who experience SCD.

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Pathophysiology

The most common electrophysiologic mechanisms leading to SCD are tachyarrhythmias such as ventricular fibrillation (VF) or ventricular tachycardia (VT). Interruption of tachyarrhythmias, using either an automatic external defibrillator (AED) or an implantable cardioverter defibrillator (ICD), has been shown to be an effective treatment for VF and VT.[1] The implantable defibrillator has become the central therapeutic factor in the prevention and treatment of sudden cardiac death. Patients with tachyarrhythmias, especially VT, carry the best overall prognosis among patients with sudden cardiac arrest (SCA).

There are multiple factors at the organ (eg imbalance of autonomic tone), tissue (eg reentry, wave break, and action potential duration alternans), cellular (eg triggered activity, and automaticity) and subcellular (abnormal activation or deactivation of ion channels) level involved in generation of VT or VF in different conditions. An anatomical or a functional block in the course of impulse propagation may create a circuit with the wave front circling around it and resulting in VT. Other mechanisms such as wave break and collisions are involved in generating VF from VT. While at the tissue level the above-mentioned reentry and wave break mechanisms are the most important known mechanisms of VT and VF, at the cellular level increased excitation or decreased repolarization reserve of cardiomyocytes may result in ectopic activity (eg automaticity, triggered activity), contributing to VT and VF initiation.

At the subcellular level, altered intracellular Ca2+ currents, altered intracellular K+ currents (especially in ischemia), or mutations resulting in dysfunction of a sodium channel (Na+ channelopathy) can increase the likelihood of VT and VF.

Approximately 20-30% of patients with documented sudden death events have bradyarrhythmia or asystole at the time of initial contact. Oftentimes, it is difficult to determine with certainty the initiating event in a patient presenting with a bradyarrhythmia because asystole and pulseless electrical activity (PEA) may result from a sustained VT. Less commonly, an initial bradyarrhythmia producing myocardial ischemia may then provoke VT or VF.

Most cases of SCD occur in patients with structural abnormalities of the heart. Myocardial infarction (MI) and post-MI remodeling of the heart is the most common structural abnormality in patients with SCD. In patients who survive a myocardial infarction, the presence of premature ventricular contractions (PVCs), particularly complex forms such as multiform PVCs, short coupling intervals (R-on-T phenomenon), or VT (salvos of 3 or more ectopic beats), reflect an increased risk of sudden death. However suppression of the PVCs with antiarrhythmic drugs increases mortality, owing to the proarrhythmic risk of currently available medications.

Hypertrophic cardiomyopathy and dilated cardiomyopathy are associated with an increased risk of SCD. Various valvular diseases such as aortic stenosis are associated with increased risk of SCD. Acute illnesses, such as myocarditis, may provide both an initial and sustained risk of SCD due to inflammation and fibrosis of the myocardium.

Less commonly, SCD happens in patients who may not have apparent structural heart disease. These conditions are usually inherited arrhythmia syndromes.

Even though many patients have anatomic and functional cardiac substrates that predispose them to develop ventricular arrhythmias, only a small percentage develop SCD. Identifying the patients at risk for SCD remains a challenge. The strongest known predictor of SCD is significant left ventricular dysfunction of any cause. The interplay between the regional ischemia, LV dysfunction, and transient inciting events (eg, worsened ischemia, acidosis, hypoxemia, wall tension, drugs, metabolic disturbances) has been proposed as being the precipitator of sudden death (see the image below).

Interplay of various risk factors that can lead toInterplay of various risk factors that can lead to sudden cardiac death.
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Epidemiology

Frequency

United States

SCD accounts for approximately 325,000 deaths per year in the United States; more deaths are attributable to SCD than to lung cancer, breast cancer, or AIDS. This represents an incidence of 0.1-0.2% per year in the adult population. SCD is often the first expression of CAD and is responsible for approximately 50% of deaths from CAD.

In several population-based studies, the incidence of out-of-hospital cardiac arrest has been noted as declining in the past 2 decades, but the proportion of sudden CAD deaths in the United States has not changed. A high incidence of SCD occurs among certain subgroups of high-risk patients (congestive heart failure with ejection fraction < 30%, convalescent phase after myocardial infarction, patients who survived cardiac arrest). However, these populations are much smaller than patients with minimal or even inapparent coronary artery disease. Consequently, in the overall population, most SCD occurs in lower risk patients. The time dependence of risk for SCD has been noted in several studies, with an increased number of events in the first 6-24 months after surviving a major cardiovascular event.

International

The frequency of SCD in Western industrialized nations is similar to that in the United States. The incidence of SCD in other countries varies as a reflection of the prevalence of coronary artery disease or other high-frequency cardiomyopathies in those populations. The trend toward increasing SCD events in developing nations of the world is thought to reflect a change in dietary and lifestyle habits in these nations. It has been estimated that SCD claims more than 7,000,000 lives per year worldwide.[2]

Mortality/Morbidity

Of more than 300,000 deaths attributed to SCD in the United States each year, a large portion (as many as 40%) are unwitnessed. For most people who experience SCD, their survival depends on the presence of individuals who are competent in performing basic life support, the rapid arrival of personnel and apparatus for defibrillation and advanced life support, and transfer to a hospital. Even under ideal circumstances, only an estimated 20% of patients who have out-of-hospital cardiac arrest survive to hospital discharge. In a study of out-of-hospital cardiac arrest survival in New York City, only 1.4% of patients survived to hospital discharge. Other studies in suburban and rural areas have indicated higher rates of survival (as high as 35%). Placement of automatic external defibrillators throughout communities and training people to use them has the potential to markedly improve outcomes from SCD.

  • Upon emergency department (ED) presentation, the most important determinants of survival include (1) an unsupported systolic blood pressure (SBP) greater than 90 mm Hg, (2) a time from loss of consciousness to return of spontaneous circulation (ROSC) of less than 25 minutes, and (3) some degree of neurological responsiveness.
  • A major adverse outcome from a SCD event is anoxic encephalopathy, which occurs in 30-80% of cases.

Race

Most studies demonstrate inconclusive data with regard to racial differences as they relate to the incidence of sudden death. Some studies suggest that a greater proportion of coronary deaths were "sudden" in blacks compared to whites. In a report by Gillum et al on SCD from 1980-1985, the percentage of coronary artery disease deaths occurring out of the hospital and in EDs was found to be higher in blacks than in whites (see the image below).[3]

Cardiac death, sudden. Plots of mortality rates (dCardiac death, sudden. Plots of mortality rates (deaths per 1000 persons) for ischemic heart disease occurring out of the hospital or in the emergency department (top) and occurring in the hospital (bottom) by age, sex, and race in 40 states during 1985.

Sex

Men have a higher incidence of SCD than women, with a ratio of 3:1. This ratio generally reflects the higher incidence of obstructive coronary artery disease in men. Recent evidence suggests that a major sex difference may exist in the mechanism of myocardial infarction. Basic and observational data point to the fact that men tend to have coronary plaque rupture, while women tend to have plaque erosion. Whether this biologic difference accounts for the male predominance of SCD is unclear.

Age

The incidence of SCD parallels the incidence of coronary artery disease, with the peak of SCD occurring in people aged 45-75 years. The incidence of SCD increases with age in men, women, whites, and nonwhites as the prevalence of coronary artery disease increases with age. However, the proportion of deaths that are sudden from coronary artery disease decreases with age. In the Framingham study, the proportion of coronary artery disease deaths that were sudden was 62% in men aged 45-54 years, but this percentage fell to 58% in men aged 55-64 years and to 42% in men aged 65-74 years.[4] According to Kuller et al, 31% of deaths are sudden in people aged 20-29 years.[5]

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Contributor Information and Disclosures
Author

Ali A Sovari, MD, FACP  Clinical and Research Fellow in Cardiovascular Medicine, Section of Cardiology, University of Illinois College of Medicine; Staff Physician and Hospitalist, St John Regional Medical Center, Cogent Healthcare, Inc

Ali A Sovari, MD, FACP is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Physiological Society, and Heart Rhythm Society

Disclosure: Nothing to disclose.

Coauthor(s)

Abraham G Kocheril, MD, FACC, FACP, FHRS  Professor of Medicine, University of Illinois College of Medicine

Abraham G Kocheril, MD, FACC, FACP, FHRS is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, Cardiac Electrophysiology Society, Central Society for Clinical Research, Heart Failure Society of America, and Illinois State Medical Society

Disclosure: Nothing to disclose.

Arnold S Baas, MD, FACC, FACP  Assistant Professor of Medicine, Division of Cardiology, University of California, Los Angeles School of Medicine; Attending Physician, UCLA Santa Monica Hospital and UCLA Westwood Hospital

Arnold S Baas, MD, FACC, FACP is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Federation for Medical Research, and American Society of Echocardiography

Disclosure: Nothing to disclose.

Specialty Editor Board

Russell F Kelly  MD, Assistant Professor, Department of Internal Medicine, Rush Medical College; Chairman of Adult Cardiology and Director of the Fellowship Program, Cook County Hospital

Russell F Kelly is a member of the following medical societies: American College of Cardiology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald J Oudiz, MD, FACP, FACC, FCCP  Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Liu Center for Pulmonary Hypertension, Division of Cardiology, LA Biomedical Research Institute at Harbor-UCLA Medical Center

Ronald J Oudiz, MD, FACP, FACC, FCCP is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physicians, American Heart Association, and American Thoracic Society

Disclosure: Actelion Grant/research funds Clinical Trials + honoraria; Encysive Grant/research funds Clinical Trials + honoraria; Gilead Grant/research funds Clinical Trials + honoraria; Pfizer Grant/research funds Clinical Trials + honoraria; United Therapeutics Grant/research funds Clinical Trials + honoraria; Lilly Grant/research funds Clinical Trials + honoraria; LungRx Clinical Trials + honoraria; Bayer Grant/research funds Consulting

Amer Suleman, MD  Private Practice

Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey N Rottman, MD  Professor of Medicine and Pharmacology, Vanderbilt University School of Medicine; Chief, Department of Cardiology, Nashville Veterans Affairs Medical Center

Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association and North American Society of Pacing and Electrophysiology (NASPE)

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Krishna Malineni, MD and Peter A McCullough, MD, MPH, FACC, FACP, FCCP to the development and writing of this article.

References

  1. [Best Evidence] Ezekowitz JA, Rowe BH, Dryden DM, et al. Systematic review: implantable cardioverter defibrillators for adults with left ventricular systolic dysfunction. Ann Intern Med. Aug 2007;21;147(4):251-62. [Medline].

  2. Mehra R. Global public health problem of sudden cardiac death. Journal of Electrocardiology. Nov-Dec 2007;40(6 Suppl):S118-22. [Medline].

  3. Gillum RF. Sudden coronary death in the United States: 1980-1985. Circulation. Apr 1989;79(4):756-65. [Medline].

  4. Kannel WB, Cupples LA, D'Agostino RB. Sudden death risk in overt coronary heart disease: the Framingham Study. Am Heart J. Mar 1987;113(3):799-804. [Medline].

  5. Kuller LH. Sudden death--definition and epidemiologic considerations. Prog Cardiovasc Dis. Jul-Aug 1980;23(1):1-12. [Medline].

  6. Thompson RJ, McCullough PA, Kahn JK. Prediction of death and neurologic outcome in the emergency department in out-of-hospital cardiac arrest survivors. Am J Cardiol. Jan 1 1998;81(1):17-21. [Medline].

  7. Thompson RJ, McCullough PA, Kahn JK. Early prediction of death and neurologic outcome in out-of-hospital sudden death survivors in the emergency department. Circulation. 1996;94:I-356.

  8. McCullough PA, Thompson RJ, Tobin KJ. Validation of a decision support tool for the evaluation of cardiac arrest victims. Clin Cardiol. Mar 1998;21(3):195-200. [Medline].

  9. Ikeda Y, Yutani C, Huang Y, et al. Histological remodeling in an ovine heart failure model resembles human ischemic cardiomyopathy. Cardiovasc Pathol. Jan-Feb 2001;10(1):19-27. [Medline].

  10. Shirani J, Pick R, Roberts WC, Maron BJ. Morphology and significance of the left ventricular collagen network in young patients with hypertrophic cardiomyopathy and sudden cardiac death. J Am Coll Cardiol. Jan 2000;35(1):36-44. [Medline].

  11. Brooks A, Schinde V, Bateman AC, Gallagher PJ. Interstitial fibrosis in the dilated non-ischaemic myocardium. Heart. Oct 2003;89(10):1255-6. [Medline].

  12. Fielitz J, Hein S, Mitrovic V, et al. Activation of the cardiac renin-angiotensin system and increased myocardial collagen expression in human aortic valve disease. J Am Coll Cardiol. Apr 2001;37(5):1443-9. [Medline].

  13. Sovari AA, Cesario D, Kocheril AG, Brugada R. Multiple episodes of ventricular tachycardia induced by silent coronary vasospasm. J Interv Card Electrophysiol. Apr 2008;21(3):223-6. [Medline].

  14. Chizner MA, Pearle DL, deLeon AC. The natural history of aortic stenosis in adults. Am Heart J. Apr 1980;99(4):419-24. [Medline].

  15. Haïssaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, de Roy L, et al. Sudden cardiac arrest associated with early repolarization. N Engl J Med. May 8 2008;358(19):2016-23. [Medline].

  16. Derval N, Simpson CS, Birnie DH, et al. Prevalence and Characteristics of Early Repolarization in the CASPER Registry Cardiac Arrest Survivors With Preserved Ejection Fraction Registry. J Am Coll Cardiol. Aug 9 2011;58(7):722-8. [Medline].

  17. Gollob MH, Redpath CJ, Roberts JD. The Short QT Syndrome Proposed Diagnostic Criteria. J Am Coll Cardiol. Feb 15 2011;57(7):802-12. [Medline].

  18. Giustetto C, Schimpf R, Mazzanti A, et al. Long-Term Follow-Up of Patients With Short QT Syndrome. J Am Coll Cardiol. Aug 2 2011;58(6):587-95. [Medline].

  19. Delise P, Allocca G, Marras E, et al. Risk stratification in individuals with the Brugada type 1 ECG pattern without previous cardiac arrest: usefulness of a combined clinical and electrophysiologic approach. Eur Heart J. Jan 2011;32(2):169-76. [Medline].

  20. Watanabe H, Chopra N, Laver D, Hwang HS, Davies SS, Roach DE. Flecainide prevents catecholaminergic polymorphic ventricular tachycardia in mice and humans. Nat Med. Apr 2009;15(4):380-3. [Medline].

  21. [Guideline] 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Circ. Nov 2 2010;[Full Text].

  22. Neumar RW, Barnhart JM, Berg RA, et al. Implementation Strategies for Improving Survival After Out-of-Hospital Cardiac Arrest in the United States: Consensus Recommendations From the 2009 American Heart Association Cardiac Arrest Survival Summit. Circulation. Jun 21 2011;123(24):2898-2910. [Medline].

  23. Bobrow BJ, Spaite DW, Berg RA, Stolz U, Sanders AB, Kern KB. Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest. JAMA. Oct 6 2010;304(13):1447-54. [Medline].

  24. Adielsson A, Hollenberg J, Karlsson T, et al. Increase in survival and bystander CPR in out-of-hospital shockable arrhythmia: bystander CPR and female gender are predictors of improved outcome. Experiences from Sweden in an 18-year perspective. Heart. Sep 2011;97(17):1391-6. [Medline].

  25. Berdowski J, Blom MT, Bardai A, Tan HL, Tijssen JG, Koster RW. Impact of Onsite or Dispatched Automated External Defibrillator Use on Survival After Out-of-Hospital Cardiac Arrest. Circulation. Nov 15 2011;124(20):2225-32. [Medline].

  26. Wenzel V, Krismer AC, Arntz HR, et al. A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation. N Engl J Med. Jan 2004;8;350(2):105-13. [Medline].

  27. Holzer M. Targeted temperature management for comatose survivors of cardiac arrest. N Engl J Med. Sep 23 2010;363(13):1256-64. [Medline].

  28. Dumas F, Grimaldi D, Zuber B, et al. Is hypothermia after cardiac arrest effective in both shockable and nonshockable patients?: insights from a large registry. Circulation. Mar 1 2011;123(8):877-86. [Medline].

  29. Moss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med. Dec 1996;26;335(26):1933-40. [Medline].

  30. Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. Mar 2002;21;346(12):877-83. [Medline].

  31. Kadish A, Dyer A, Daubert JP, et al. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med. May 2004;20;350(21):2151-8. [Medline].

  32. Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. Jan 2005;20;352(3):225-37. [Medline].

  33. Bardy GH, Lee KL, Mark DB, et al. Home Use of Automated ExternalDefibrillators for Sudden Cardiac Arrest. N Engl J Med. Apr 2008;24;358(17):1793-804. [Medline].

  34. Altemose GT, Buxton AE. Idiopathic ventricular tachycardia. Annu Rev Med. 1999;50:159-77. [Medline].

  35. Anderson KP, Freedman RA, Mason JW. Sudden death in idiopathic dilated cardiomyopathy. Ann Intern Med. Jul 1987;107(1):104-6. [Medline].

  36. Antiarrhythmics Versus Implantable Defibrillators Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. N Engl J Med. Nov 27 1997;337(22):1576-83. [Medline].

  37. Bayes de Luna A, Coumel P, Leclercq JF. Ambulatory sudden cardiac death: mechanisms of production of fatal arrhythmia on the basis of data from 157 cases. Am Heart J. Jan 1989;117(1):151-9. [Medline].

  38. Belhassen B, Viskin S. Idiopathic ventricular tachycardia and fibrillation. J Cardiovasc Electrophysiol. Jun 1993;4(3):356-68. [Medline].

  39. Benditt DG, Pritchett LC, Smith WM, et al. Characteristics of atrioventricular conduction and the spectrum of arrhythmias in Lown-Ganong-Levine syndrome. Circulation. Mar 1978;57(3):454-65. [Medline].

  40. Berger S, Dhala A, Friedberg DZ. Sudden cardiac death in infants, children, and adolescents. Pediatr Clin North Am. Apr 1999;46(2):221-34. [Medline].

  41. Beta-blocker Heart Attack Research Group. A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results. JAMA. Mar 26 1982;247(12):1707-14. [Medline].

  42. Bigger JT. Prophylactic use of implanted cardiac defibrillators in patients at high risk for ventricular arrhythmias after coronary-artery bypass graft surgery. Coronary Artery Bypass Graft (CABG) Patch Trial Investigators. N Engl J Med. Nov 27 1997;337(22):1569-75. [Medline].

  43. Bigger JT, Fleiss JL, Kleiger R. The relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality in the 2 years after myocardial infarction. Circulation. Feb 1984;69(2):250-8. [Medline].

  44. Blackstone EH, Kirklin JW. Death and other time-related events after valve replacement. Circulation. Oct 1985;72(4):753-67. [Medline].

  45. Bromberg BI, Lindsay BD, Cain ME. Impact of clinical history and electrophysiologic characterization of accessory pathways on management strategies to reduce sudden death among children with Wolff-Parkinson-White syndrome. J Am Coll Cardiol. Mar 1 1996;27(3):690-5. [Medline].

  46. Brugada J, Brugada R, Brugada P. Right bundle-branch block and ST-segment elevation in leads V1 through V3: a marker for sudden death in patients without demonstrable structural heart disease. Circulation. Feb 10 1998;97(5):457-60. [Medline].

  47. Brugada P, Brugada J. A distinct clinical and echocardiographic syndrome: right bundle branch block, persistent ST segment elevation with normal QT interval and sudden cardiac death. PACE. 1991;14:746-51.

  48. Brugada R, Hong K, Cordeiro JM. Short QT syndrome. CMAJ. 2005;173(11):1349-54.

  49. Burkart F, Pfisterer M, Kiowski W. Effect of antiarrhythmic therapy on mortality in survivors of myocardial infarction with asymptomatic complex ventricular arrhythmias: Basel Antiarrhythmic Study of Infarct Survival (BASIS). J Am Coll Cardiol. Dec 1990;16(7):1711-8. [Medline].

  50. Burke AP, Farb A, Malcom GT. Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med. May 1 1997;336(18):1276-82. [Medline].

  51. Cairns JA, Connolly SJ, Roberts R. Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Investigators. Lancet. Mar 8 1997;349(9053):675-82. [Medline].

  52. Cardiac Arrhythmia Suppression Trial Investigators. Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. The Cardiac Arrhythmia Suppression Trial (CAST) Investigators. N Engl J Med. Aug 10 1989;321(6):406-12. [Medline].

  53. Chang D, Goldstein S. Sudden cardiac death in ischemic heart disease. Compr Ther. Feb 1997;23(2):95-103. [Medline].

  54. Corrado D, Basso C, Thiene G. Spectrum of clinicopathologic manifestations of arrhythmogenic right ventricular cardiomyopathy/dysplasia: a multicenter study. J Am Coll Cardiol. Nov 15 1997;30(6):1512-20. [Medline].

  55. Davies MJ. The investigation of sudden cardiac death. Histopathology. Feb 1999;34(2):93-8. [Medline].

  56. Davies MJ, Thomas A. Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. N Engl J Med. May 3 1984;310(18):1137-40. [Medline].

  57. de Vreede-Swagemakers JJ, Gorgels AP, Dubois-Arbouw WI, van Ree JW, Daemen MJ, Houben LG, et al. Out-of-hospital cardiac arrest in the 1990's: a population-based study in the Maastricht area on incidence, characteristics and survival. J Am Coll Cardiol. Nov 15 1997;30(6):1500-5. [Medline].

  58. DeRose JJ, Banas JS, Winters SL. Current perspectives on sudden cardiac death in hypertrophic cardiomyopathy. Prog Cardiovasc Dis. May-Jun 1994;36(6):475-84. [Medline].

  59. Domanski MJ, Zipes DP, Schron E. Treatment of sudden cardiac death. Current understandings from randomized trials and future research directions. Circulation. Jun 17 1997;95(12):2694-9. [Medline].

  60. Doval HC, Nul DR, Grancelli HO. Nonsustained ventricular tachycardia in severe heart failure. Independent marker of increased mortality due to sudden death. GESICA- GEMA Investigators. Circulation. Dec 15 1996;94(12):3198-203. [Medline].

  61. Doyle JT, Kannel WB, McNamara PM. Factors related to suddenness of death from coronary disease: combined Albany-Framingham studies. Am J Cardiol. Jun 1976;37(7):1073-8. [Medline].

  62. Driscoll DJ, Edwards WD. Sudden unexpected death in children and adolescents. J Am Coll Cardiol. Jun 1985;5(6 Suppl):118B-121B. [Medline].

  63. Echt DS, Liebson PR, Mitchell LB. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial. N Engl J Med. Mar 21 1991;324(12):781-8. [Medline].

  64. Ehtisham J, Watkins H. Is Wolff-Parkinson-White syndrome a genetic disease?. J Cardiovasc Electrophysiol. 2005;16(11):1258-62.

  65. Garson A, McNamara DG. Sudden death in a pediatric cardiology population, 1958 to 1983: relation to prior arrhythmias. J Am Coll Cardiol. Jun 1985;5(6 Suppl):134B-137B. [Medline].

  66. Gillum RF. Coronary heart disease in black populations. I. Mortality and morbidity. Am Heart J. Oct 1982;104(4 Pt 1):839-51. [Medline].

  67. Gilman JK, Jalal S, Naccarelli GV. Predicting and preventing sudden death from cardiac causes. Circulation. Aug 1994;90(2):1083-92. [Medline].

  68. Goldberger JJ. Treatment and prevention of sudden cardiac death: effect of recent clinical trials. Arch Intern Med. Jun 28 1999;159(12):1281-7. [Medline].

  69. Goldstein S. The necessity of a uniform definition of sudden coronary death: witnessed death within 1 hour of the onset of acute symptoms. Am Heart J. Jan 1982;103(1):156-9. [Medline].

  70. Goldstein S, Landis JR, Leighton R. Characteristics of the resuscitated out-of-hospital cardiac arrest victim with coronary heart disease. Circulation. Nov 1981;64(5):977-84. [Medline].

  71. Gottlieb SS. The use of antiarrhythmic agents in heart failure: implications of CAST. Am Heart J. Nov 1989;118(5 Pt 1):1074-7. [Medline].

  72. Holmes DR, Davis KB, Mock MB. The effect of medical and surgical treatment on subsequent sudden cardiac death in patients with coronary artery disease: a report from the Coronary Artery Surgery Study. Circulation. Jun 1986;73(6):1254-63. [Medline].

  73. Iseri LT, Humphrey SB, Siner EJ. Prehospital brady-asystolic cardiac arrest. Ann Intern Med. Jun 1978;88(6):741-5. [Medline].

  74. Itoh H, Horie M, Ito M. Arrhythmogenesis in the short-QT syndrome associated with combined HERG channel gating defects: a simulation study. Circ J. 2006;70(4):502-8.

  75. Jaoude SA, Leclercq JF, Coumel P. Progressive ECG changes in arrhythmogenic right ventricular disease. Evidence for an evolving disease. Eur Heart J. Nov 1996;17(11):1717-22. [Medline].

  76. Kunavarapu C, Bloomfield DM. Role of noninvasive studies in risk stratification for sudden cardiac death. Clin Cardiol. 2004;27(4):192-7.

  77. Ladich E, Virmani R, Burke A. Sudden cardiac death not related to coronary atherosclerosis. Toxicol Pathol. 2006;34(1):52-7.

  78. Latini R, Maggioni AP, Flather M. ACE inhibitor use in patients with myocardial infarction. Summary of evidence from clinical trials. Circulation. Nov 15 1995;92(10):3132-7. [Medline].

  79. Lerman BB, Stein KM, Markowitz SM. Idiopathic right ventricular outflow tract tachycardia: a clinical approach. Pacing Clin Electrophysiol. Dec 1996;19(12 Pt 1):2120-37. [Medline].

  80. Lombardi G, Gallagher J, Gennis P. Outcome of out-of-hospital cardiac arrest in New York City. The Pre- Hospital Arrest Survival Evaluation (PHASE) Study. JAMA. Mar 2 1994;271(9):678-83. [Medline].

  81. Makikallio TH, Barthel P, Schneider R. Frequency of sudden cardiac death among acute myocardial infarction survivors with optimized medical and revascularization therapy. Am J Cardiol. 2006;15;97(4):480-4.

  82. Marcus FI, Fontaine GH, Guiraudon G. Right ventricular dysplasia: a report of 24 adult cases. Circulation. Feb 1982;65(2):384-98. [Medline].

  83. Maron BJ, Bonow RO, Cannon RO. Hypertrophic cardiomyopathy. Interrelations of clinical manifestations, pathophysiology, and therapy (2). N Engl J Med. Apr 2 1987;316(14):844-52. [Medline].

  84. Maron BJ, Epstein SE, Roberts WC. Causes of sudden death in competitive athletes. J Am Coll Cardiol. Jan 1986;7(1):204-14. [Medline].

  85. Maron BJ, Shirani J, Poliac LC. Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles. JAMA. Jul 17 1996;276(3):199-204. [Medline].

  86. Maseri A, Severi S, Marzullo P. Role of coronary arterial spasm in sudden coronary ischemic death. Ann N Y Acad Sci. 1982;382:204-17. [Medline].

  87. Metoprolol in Acute Myocardial Infarction Trial Research Group. Metoprolol in acute myocardial infarction (MIAMI). A randomised placebo- controlled international trial. The MIAMI Trial Research Group. Eur Heart J. Mar 1985;6(3):199-226. [Medline].

  88. Moss AJ. Prognosis after myocardial infarction. Am J Cardiol. Oct 1 1983;52(7):667-9. [Medline].

  89. Moss AJ, Schwartz PJ, Crampton RS. The long QT syndrome. Prospective longitudinal study of 328 families. Circulation. Sep 1991;84(3):1136-44. [Medline].

  90. Myerburg RJ, Castellanos A. Cardiac arrest and sudden cardiac death. In: Brunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine. 4th ed. Philadelphia, Pa: WB Saunders; 1992:. 756-89.

  91. Myerburg RJ, Estes D, Zaman L. Outcome of resuscitation from bradyarrhythmic or asystolic prehospital cardiac arrest. J Am Coll Cardiol. Dec 1984;4(6):1118-22. [Medline].

  92. Myerburg RJ, Kessler KM, Castellanos A. Sudden cardiac death. Structure, function, and time-dependence of risk. Circulation. Jan 1992;85(1 Suppl):I2-10. [Medline].

  93. Nademanee K, Singh BN, Stevenson WG. Amiodarone and post-MI patients. Circulation. Aug 1993;88(2):764-74. [Medline].

  94. Napolitano C, Bloise R, Priori SG. Long QT syndrome and short QT syndrome: how to make correct diagnosis and what about eligibility for sports activity. J Cardiovasc Med (Hagerstown). 2006;7(4):250-6.

  95. Narasimhan C, Jazayeri MR, Sra J. Ventricular tachycardia in valvular heart disease: facilitation of sustained bundle-branch reentry by valve surgery. Circulation. Dec 16 1997;96(12):4307-13. [Medline].

  96. Neuspiel DR, Kuller LH. Sudden and unexpected natural death in childhood and adolescence. JAMA. Sep 13 1985;254(10):1321-5. [Medline].

  97. Prystowsky EN. Prevention of sudden cardiac death. Clin Cardiol. 2005;28(11 Suppl 1):I12-8.

  98. Rosen MR, Jause MJ, Myerburg RJ. Arrhythmias induced by coronary artery occlusion: what are the electrophysiologic mechanisms? In: Hearse DJ, Mannings AS, Janse M, eds. Life-Threatening Arrhythmias During Ischemia and Infarction. New York, NY: Raven; 1987:. 11-47.

  99. Sarkozy A, Brugada P. Sudden cardiac death and inherited arrhythmia syndromes. J Cardiovasc Electrophysiol. 2005;16 Suppl 1:S8-20.

  100. Schoenfeld MH, McGovern B, Garan H. Determinants of the outcome of electrophysiologic study in patients with ventricular tachyarrhythmias. J Am Coll Cardiol. Aug 1985;6(2):298-306. [Medline].

  101. Spirito P, Seidman CE, McKenna WJ. The management of hypertrophic cardiomyopathy. N Engl J Med. Mar 13 1997;336(11):775-85. [Medline].

  102. Sra J, Akhtar M. Recent advances in understanding the mechanisms, diagnosis and treatment of congenital and acquired long QT syndrome. Indian Heart J. Nov-Dec 1996;48(6):639-51. [Medline].

  103. Stern S, Tzivoni D. Ventricular arrhythmias, sudden death, and silent myocardial ischemia. Prog Cardiovasc Dis. Jul-Aug 1992;35(1):19-26. [Medline].

  104. Stevenson WG, Stevenson LW, Middlekauff HR. Sudden death prevention in patients with advanced ventricular dysfunction. Circulation. Dec 1993;88(6):2953-61. [Medline].

  105. Tamburro P, Wilber D. Sudden death in idiopathic dilated cardiomyopathy. Am Heart J. Oct 1992;124(4):1035-45. [Medline].

  106. Tapanainen JM, Lindgren KS, Makikallio TH. Natriuretic peptides as predictors of non-sudden and sudden cardiac death after acute myocardial infarction in the beta-blocking era. J Am Coll Cardiol. 2004;43(5):757-63.

  107. Viskin S, Lesh MD, Eldar M. Mode of onset of malignant ventricular arrhythmias in idiopathic ventricular fibrillation. J Cardiovasc Electrophysiol. Oct 1997;8(10):1115-20. [Medline].

  108. Watkins H, McKenna WJ, Thierfelder L. Mutations in the genes for cardiac troponin T and alpha-tropomyosin in hypertrophic cardiomyopathy. N Engl J Med. Apr 20 1995;332(16):1058-64. [Medline].

  109. Wellens HJ, Durrer D. Wolff-Parkinson-White syndrome and atrial fibrillation. Relation between refractory period of accessory pathway and ventricular rate during atrial fibrillation. Am J Cardiol. Dec 1974;34(7):777-82. [Medline].

  110. Westenskow P, Splawski I, Timothy KW. Compound mutations: a common cause of severe long-QT syndrome. Circulation. 2004;109(15):1834-41.

  111. Winslow RD, Mehta D, Fuster V. Sudden cardiac death: mechanisms, therapies and challenges. Nat Clin Pract Cardiovasc Med. 2005;2(7):352-60.

  112. Yusuf S, Peto R, Lewis J. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis. Mar-Apr 1985;27(5):335-71. [Medline].

  113. Zipes DP, Wellens HJ. Sudden cardiac death. Circulation. Nov 24 1998;98(21):2334-51. [Medline].

 
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Interplay of various risk factors that can lead to sudden cardiac death.
Cardiac death, sudden. Plots of mortality rates (deaths per 1000 persons) for ischemic heart disease occurring out of the hospital or in the emergency department (top) and occurring in the hospital (bottom) by age, sex, and race in 40 states during 1985.
Cardiac death, sudden. Figure a shows neurologic outcome stratified by initial cardiac arrest score. Neurologic recovery is defined as discharged home and able to care for self. Figure b shows overall survival stratified by initial cardiac arrest score.
Cardiac death, sudden. Epsilon wave in a patient with arrhythmogenic right ventricular dysplasia.
Cardiac death, sudden. Ventricular fibrillation appeared during rapid atrial fibrillation in a patient with Wolff-Parkinson-White syndrome.
 
 
 
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