eMedicine Specialties > Cardiology > Arrhythmias

Sudden Cardiac Death: Treatment & Medication

Author: Ali A Sovari, MD, Clinical and Research Fellow in Cardiovascular Medicine, Section of Cardiology, University of Illinois at Chicago
Coauthor(s): Abraham G Kocheril, MD, FACC, FACP, Professor of Medicine, Director of Clinical Electrophysiology, University of Illinois at Chicago; 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
Contributor Information and Disclosures

Updated: Oct 21, 2009

Treatment

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 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:

  • 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.17 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.

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.18

This study was followed by MADIT-2, demonstrating that post-MI patients with an LVEF ≤30% have a survival benefit with ICD implantation.19 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.20

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.21

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.22 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.

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 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.

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.

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.

Medication

Medications are prescribed on an individual basis, depending on the underlying cause of SCD.

More on Sudden Cardiac Death

Overview: Sudden Cardiac Death
Differential Diagnoses & Workup: Sudden Cardiac Death
Treatment & Medication: Sudden Cardiac Death
Follow-up: Sudden Cardiac Death
Multimedia: Sudden Cardiac Death
References
[ CLOSE WINDOW ]

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. 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].

  17. 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].

  18. 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].

  19. 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].

  20. 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].

  21. 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].

  22. 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].

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

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

  25. 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].

  26. 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].

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

  28. 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].

  29. 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].

  30. 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].

  31. 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].

  32. 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].

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

  34. 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].

  35. 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].

  36. 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.

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

  38. 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].

  39. 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].

  40. 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].

  41. 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].

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

  43. 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].

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

  45. 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].

  46. 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].

  47. 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].

  48. 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].

  49. 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].

  50. 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].

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

  52. 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].

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

  54. 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].

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

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

  57. 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].

  58. 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].

  59. 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].

  60. 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].

  61. 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].

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

  63. 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.

  64. 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].

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

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

  67. 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].

  68. 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].

  69. 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].

  70. 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.

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

  72. 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].

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

  74. 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].

  75. 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].

  76. 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].

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

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

  79. 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.

  80. 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].

  81. 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].

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

  83. 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.

  84. 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].

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

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

  87. 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.

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

  89. 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].

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

  91. 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].

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

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

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

  95. 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.

  96. 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].

  97. 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].

  98. 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].

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

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

  101. 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].

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

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

cardiac arrest, sudden cardiac death, cardiac arrhythmias, heart attack, myocardial infarction, heart failure, cardiac disease, coronary artery disease, coronary heart disease, congestive heart failure

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Ali A Sovari, MD, Clinical and Research Fellow in Cardiovascular Medicine, Section of Cardiology, University of Illinois at Chicago
Ali A Sovari, MD is a member of the following medical societies: American College of Physicians and American Heart Association
Disclosure: Nothing to disclose.

Coauthor(s)

Abraham G Kocheril, MD, FACC, FACP, Professor of Medicine, Director of Clinical Electrophysiology, University of Illinois at Chicago
Abraham G Kocheril, MD, FACC, FACP 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: Pfizer Honoraria Speaking and teaching

Medical Editor

Russell F Kelly, MD, Program Director, Assistant Professor, Department of Internal Medicine, Division of Cardiology, Cook County Hospital, Rush Medical College
Russell F Kelly, MD is a member of the following medical societies: American College of Cardiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
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, Director, Clinical Cardiac Electrophysiology Fellowship Program, 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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
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.