Sudden Cardiac Death Treatment & Management

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

Medical Care

Advanced cardiac life support (ACLS): In the event of cardiac arrest, the immediate implementation of ACLS guidelines is indicated. Widespread interest in improving rates of public ACLS training with a special emphasis on use of early defibrillation by public service personnel (eg, police, fire, airline attendants) exists. Through these measures, the greatest public health benefits can be achieved in the fight against sudden death. In 2010, the American Heart Association (AHA) published new Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science.[21]

The 2009 American Heart Association Cardiac Arrest Survival Summit released consensus recommendations for implementation strategies to optimize the care of patients with out-of-hospital sudden cardiac arrest (OHCA).[22] These recommendations included collection of national data on OHCA and local culture changes because incomplete implementation of existing standards was seen as the limiting problem.

In general, ACLS guidelines should be followed in all cases of SCA; however, depending on the presented rhythm, the following should be considered in acute therapy of SCA:

Bystander CPR

The best techniques for bystander CPR continue to evolve based on rigorous scientific evaluation and considerations of practical applicability. Recent data suggest, for example, that compression-only CPR may be of equal or greater effectiveness than traditional compression plus ventilation techniques.[23]

Adielsson et al suggest that the long-term perspective data among patients in VF or pulseless VT who were given bystander CPR revealed that survival to 1 month after VF almost doubled.[24]

Berdowski and colleagues in a recent cohort study demonstrated that the bystander use of automated external defibrillators can reduce the time to defibrillation from 11 minutes to 4.1 minutes and improves neurologically intact survival to discharge from 14.3% to 49.6%.[25] That observation is consistent with already known facts that the main initiating mechanisms of sudden cardiac death are ventricular tachycardia and ventricular fibrillation, and that time to defibrillation is a critical factor in restoring the rhythm.

The conclusion that may be drawn from the above studies is that immediate chest compression and defibrillation are the most important interventions to improve the outcome in sudden cardiac arrest, whereas ventilation does not play as important a role.

Ventricular arrhythmia (VF and VT)

Defibrillation is the mainstay of the acute therapy of SCA due to VF or VT. Epinephrine (1 mg q3-5min) or vasopressin (40 U single dose) are given. Amiodarone (300 mg IV push and 150 mg repeat IV push if needed) and lidocaine (1 mg/kg IV push q3-5min up to 3 doses) can be used as antiarrhythmic drugs if defibrillation does not control the VF/VT. In case of polymorphic VT or suspected hypomagnesemia, 1-2 g IV push of magnesium is recommended.

Pulseless electrical activity (PEA)

Epinephrine (1 mg q3-5min) can be used as there is no evidence supporting the use of vasopressin in PEA. Atropine (1 mg q3-5min) should be used in case of bradycardia. Sodium bicarbonate (1 meq/kg) should be given if there is associated hyperkalemia and its use may be considered in long arrest intervals and suspected metabolic acidosis.

Asystole

One study suggested that vasopressin is more effective in acute therapy of asystole than epinephrine.[26] Atropine and sodium bicarbonate are used with similar indications in PEA.

Medical stabilization

Careful postresuscitative care is essential to survival because studies have shown a 50% repeat inhospital arrest rate for people admitted after an SCD event. Treatment of myocardial ischemia, heart failure, and electrolyte disturbances are all justified by the results of multiple acute MI and congestive heart failure randomized trials. Empiric beta-blockers are reasonable in many circumstances because of favorable properties discussed in Causes. Empiric antiarrhythmics, including amiodarone, should not supersede ICD implantation unless control of recurrent VT is needed while the patient is in the hospital.

Therapeutic hypothermia

This intervention limits neurologic injury associated with brain ischemia during a cardiac arrest and reperfusion injury associated with resuscitation.[27]

There are several plausible ways that therapeutic hypothermia may prevent neurologic injury, including reduction in metabolism and oxygen consumption of the brain, inhibition of glutamate and dopamine release, and prevention of oxidative stress and apoptosis. Therefore, therapeutic hypothermia should be considered for patients who have been successfully resuscitated from SCA and who are comatose.

In a prospective study of 1145 consecutive patients with out-of-hospital cardiac arrest who had successful resuscitation, therapeutic hypothermia was associated with increased odds of good neurological outcome (odds ratio, 1.9; 95% confidence interval, 1.18-3.06) in patients with VT or VF.[28]

Therapeutic hypothermia is more effective in patients with initial rhythm of VF/VT but is also recommended for patients presenting with asystole and PEA.

Patients who should not receive this therapy include (1) those with tympanic membrane temperature of below 30ºC at the time of presentation, (2) those who were comatose before SCA, (3) those who are pregnant, (4) those who have inherited coagulation disorders, and (5) those who are terminally ill. Two main techniques for induction of therapeutic hypothermia are surface cooling methods with the use of precooled surface cooling pads and core cooling methods with the use of cold intravenous fluids.

Primary prevention of SCD

Several studies have evaluated the use of prophylactic ICDs in patients who have not yet experienced SCD but are at high risk for future SCD. The first of these trials, Multicenter Automatic Defibrillator Implantation Trail (MADIT) demonstrated that patients with ischemic cardiomyopathy (LVEF ≤35%) and inducible but nonsuppressible VT on EPS had a survival advantage by implanting an ICD.[29]

This study was followed by MADIT-2, demonstrating that post-MI patients with an LVEF ≤30% have a survival benefit with ICD implantation.[30] The Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation (DEFINITE) study showed that implantation of an ICD reduced the risk of sudden cardiac death in a patient population of nonischemic cardiomyopathy (LVEF < 36%) who also had PVCs or nonsustained VT.[31]

Finally, the Sudden Cardiac Death in Heart Failure Trial (SCD-Heft) demonstrated that patients with either ischemic or nonischemic cardiomyopathy on optimal medical therapy, LVEF ≤35%, and NYHA II or III treated with an ICD demonstrate greater survival as compared with either amiodarone or placebo.[32]

The recent Home Automated Defibrillator Trial (HAT) demonstrated no survival benefit for the use of a home AED in patients surviving a recent anterior MI who were not candidates for an ICD.[33] However, the overall mortality and incidence of SCD was much lower than predicted from previous data and the noncardiac mortality was as high as cardiac mortality in the population of this study. These factors led to much less power than initially projected in this trial to detect a significant difference in the mortality rate between the arms.

The use of microvolt T wave alternans (MTWA) to determine which patients with depressed LV systolic function would best benefit from prophylactic ICD placement has been the subject of several recent clinical trials. To date, the results of these clinical trials has not been conclusive.

Next

Surgical Care

Temporary cardiac pacing

Transcutaneous of transvenous cardiac pacing may be considered in the patients with bradycardia and asystole.

Radiofrequency ablation

Radiofrequency ablation, now routinely available, may be indicated for patients with accessory pathways, bundle-branch block VT, RVOT VT, idiopathic LV tachycardia, and more rare forms of automatic focus VT. Unfortunately, most cases of SCD are not amenable to radiofrequency ablation and require ICD implantation. Radiofrequency ablation may be useful in the treatment of patients with SCD who experience frequent recurrent VT/VF after ICD placement, especially those who require frequent defibrillation.

Cardioverter defibrillator therapy

Several multicenter trials examining the prophylactic use of cardioverter defibrillator therapy in patients at high risk for SCD have been performed.

The annual SCD rate in patients with these devices has been reduced from 25% to 1-2%. Studies have shown that in patients at high risk in whom electrophysiologic-guided therapy with antiarrhythmics has failed, ICD placement is beneficial. In several studies comparing ICD placement to antiarrhythmic therapy in patients with VT and/or prior cardiac arrest, ICD placement has been shown to be associated with decreased mortality.

The use of ICDs for primary prevention of SCD is now standard care for most patients with LVEF ≤35%. Newer ICDs with pacing capabilities have addressed bradyarrhythmias either causing or complicating VT or VF.

Cardiac surgery

Cardiac surgery can be a primary treatment for SCD via a variety of strategies.

Surgical treatment in patients with ventricular arrhythmias and ischemic heart disease includes coronary artery bypass grafting (CABG). The CASS study illustrated that patients with significant CAD and operable vessels who underwent CABG had a decrease in the incidence of sudden death when compared to patients on conventional medical treatment. The reduction was most evident in patients who had 3-vessel disease and CHF.

Surgical treatment of ventricular arrhythmias in patients with nonischemic heart disease includes excision of VT foci after endocardial mapping and excision of LV aneurysms. This is performed with decreasing frequency, because of perioperative mortality and the alternative, transvenous ICD implantation.

Aortic valve replacement is associated with improved outcome in patients with hemodynamically significant valvular stenosis and well-preserved ventricular function. In patients with MVP associated with significant valvular regurgitation and LV dysfunction, malignant tachyarrhythmias and SCD have been reported. These patients are candidates for mitral valve repair or replacement.

Orthotopic heart transplantation is indicated in cases of SCD and refractory heart failure in which significant improvement in actuarial survival is expected. Given a limited donor service, this form of treatment is expected to be beneficial for very few people who survive SCD.

Patients with long QT syndrome who do not respond to beta-blockers are candidates for ICD implantation or high thoracic left sympathectomy.

Previous
Next

Consultations

A cardiologist always should be participating in the care of these patients. Cardiac electrophysiologists should be involved in the care of these patients, which generally involves ICD implantation.

Other consultations for expertise include an interventional cardiologist and cardiac surgeon and are made on an individual basis.

Previous
Next

Diet

Patients with coronary artery disease are advised to follow a diet low in fat and cholesterol. Patients with severe heart failure should monitor their fluid and sodium intake.

Previous
Proceed to Medication
 
 
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].

 
Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.