Guidelines for Risks and Prevention of Sudden Cardiac Death (JCS 2010) - Digest Version (original) (raw)

Task Force on Sudden Cardiac Death of the European Society of Cardiology

European Heart Journal, 2001

This comprehensive, educational document on sudden cardiac death is an extensive review that was deemed necessary for two reasons: first, major studies have advanced our knowledge of the natural history, risk prediction and evaluation, and prevention of tachyarrhythmias and sudden death in patients with coronary artery disease or heart failure; second, in rare or previously unknown diseases, the recognition of high risk patients is more difficult since studies are either lacking or they are less likely to be performed.

Task Force on Sudden Cardiac Death, European Society of Cardiology

Europace

The European Society of Cardiology has convened a Task Force on Sudden Cardiac Death in order to provide a comprehensive, educational document on this important topic. The main document has been published in the European Heart Journal in August 2001 [1]. The Task Force has now summarized the most important clinical issues on sudden cardiac death and provided tables with recommendations for risk stratification and for prophylaxis of sudden cardiac death. The present recommendations are specifically intended to encourage the development and revision of national guidelines on prevention of sudden cardiac death. The common challenge for cardiologists, physicians of other medical specialties and health professionals throughout Europe is to realize the potential for sudden cardiac death prevention and to contribute to public health efforts to reduce its burden.

EC CARDIOLOGY Sudden Cardiac Death: Some Considerations On the Matter

Heart disease remains the leading cause of death worldwide. The Sudden cardiac death (or better the Unexpected Cardiac Death) can appear at any time and anywhere. Despite being the most wrenching event that any physician can find, (when it occurs in childhood the tragedy is supreme), the called " sudden cardiac death " is still quite unknown in its most intimate mechanisms of production. Delays in diagnosis, a big lack of previous diagnosis in many cases, as well as the immense discrepancies and controversies among the various authors, are the keys for such lack of knowledge. Lately, the implementation of semiautomatic defibrillators on the streets, supermarkets and the education of non-specialists people, is a quite effective method for the recovery and survival of people who have suffered such a wrenching event. Problem? Not work if do not capture heartbeat. Some deep and well documented studies are making possible the creation of some " risk score " for suffer an " unexpected cardiac death. " This can be very beneficial to its prevention, through an advice and pertinent medical interventions. (Thompson and Mc-Cullough score. Rajat and Faye score: Appurtenances 1 and 2). Unfortunately – at this time-, only around the 15% of people who have suffered this type of event is recovered. And of this 15% of people recovered, more than 85% will suffer some sort of neurological disorder for all life. Most sudden deaths occur outside the hospital, on the street. This considerably reduces the total recovery process. Also unfortunately, the discrepancies about the concept and management of such infamous situation are still very bountiful among medical professionals. The discrepancies about how it must be defined, what actions are necessary immediately to its apparition, and many other issues more, remain overwhelming. Here we will discuss some nuances about them. By way of example, the meaning of " sudden " does not mean " unexpected " necessarily. For Framingham Heart Study, sudden cardiac death is defined as: " death because of CHD occurring within 1 hour of symptom onset and not likely attributable to other causes ". We put 'called into question' this definition. We could say: " All the unexpected is sudden. Not all the sudden is unexpected ". We think this event should be called as: Unexpected cardiac death. As for the overall management of such an event, there are also many differences and controversies among the different authors. This subject also will be discussed in the document.

Sudden cardiac death: epidemiology and risk factors

Nature reviews. Cardiology, 2010

Sudden cardiac death (SCD) is an important public-health problem with multiple etiologies, risk factors, and changing temporal trends. Substantial progress has been made over the past few decades in identifying markers that confer increased SCD risk at the population level. However, the quest for predicting the high-risk individual who could be a candidate for an implantable cardioverter-defibrillator, or other therapy, continues. In this article, we review the incidence, temporal trends, and triggers of SCD, and its demographic, clinical, and genetic risk factors. We also discuss the available evidence supporting the use of public-access defibrillators.

Sudden cardiac death: Prevalence, pathogenesis, and prevention

Annals of Medicine, 2008

Sudden cardiac death (SCD), also known as sudden arrest, is a major health problem worldwide. It is usually defined as an unexpected death from a cardiac cause occurring within a short time in a person with or without preexisting heart disease. The pathogenesis of SCD is complex and multifaceted. A dynamic triggering factor usually interacts with an underlying heart disease, either genetically determined or acquired, and the final outcome is the development of lethal tachyarrhythmias or, less frequently, bradycardia. It has increasingly been highlighted that a reliable clinical and diagnostic approach might be effective to unmask the most important genetic and environmental factors, allowing the construction of a rational personalized medicine framework that can be applied in both the preclinical and clinical settings of SCD. The aim of the present article is to provide a concise overview of prevalence, pathogenesis, clinical presentation, and diagnostic approach to this challenging disorder.

Risk of sudden cardiac death

The aim of this study was to determine characteristics of patients with sudden cardiac arrest (SCA) and/or sudden cardiac death (SCD). We need an effective risk stratification method for SCD in patients without low left ventricular ejection fraction (LVEF).

ECG is not a reliable predictor of sudden cardiac death in the general population

World Journal of Cardiovascular Diseases, 2013

Objectives: To determine the predictive value of the ECG for sudden death in the general population. Design: In the Copenhagen City Heart Study, a randomly selected population sample in Copenhagen, Denmark has been followed prospectively since 1976. From this population sample, we analyzed ECGs of individuals who had suffered sudden cardiac death (SCD) before the age of 50 years and compared them with ECGs of a randomly selected control individuals from the same population sample. Specific ECG signs that could point toward a condition associated with a risk of SCD were noted. Results: From a total of 18,974 individuals in the cohort, 207 had died at an age younger than 50 years. Among these, 24 persons with SCD were identified. The most prevalent ECG abnormality was QRS fragmentation. We found no ECGs with long or short QTc, Brugada sign or WPW. The prevalence of signs of left ventricular hypertrophy, early repolarization, or fragmentation was not different from the prevalence of these signs in the control group. Conclusion: In the Copenhagen City Heart Study, the ECG failed to predict SCD in persons who died before the age of 50 years.

The Prevention of Sudden Death: New Perspectives

Current News in Cardiology, 2007

Sudden cardiac death (SCD) is unexpected natural death due to cardiac causes, and includes the abrupt loss of consciousness within 1 h from the onset of acute symptoms, with or without preexisting heart disease. It is very difficult to evaluate the exact incidence of SCD because the concept of "sudden events" has not been precisely defined [1]. Estimates for the US show a mean incidence of 300,000 SCDs per year, 0.1-0.2% of the entire population [1]. In Italy, the number of events per year is around 50,000 (about 1/1,000 subjects/year) [2]. These estimates are related to the whole population, thus including SCDs as a primary cardiac event in healthy subjects and those occurring in high-risk patients. Despite the high number of events per year in the population, the percentage remains very low although it has increased progressively in high-risk subgroups. For example, in post-myocardial infarction (MI) patients and in subjects with prior malignant ventricular tachyarrhythmias the incidence of SCD is 35% [1]. In a Framingham Study re-analysis, risk factors for coronary artery disease were shown to be statistically related to SCD. The incidence in patients with several risk factors is 60 times higher than in those with only one [3]. Therefore, considering that the 80% of SCD is due to ischemic events, primary and secondary coronary artery disease prevention is of major importance. According to international guidelines and evidence-based medicine, the control of risk factors and of pharmacological treatment is very important.

Fighting against sudden death: A single or multidisciplinary approach

Journal of Interventional Cardiac Electrophysiology, 2006

There are many causes of sudden death ranging from accidents and suicide to vascular events and arrhythmias. Most sudden deaths will occur in people who have not been diagnosed with a serious heart condition but at a very low annual rate. Many of these events are probably vascular and might be prevented by reducing the risk of developing coronary disease. Only a minority of sudden deaths occur in people with established cardiac disease, but in patients with major structural heart disease, the annual rate is high. The causes of sudden death are many in this clinical setting also, but dominated by ventricular arrhythmias and vascular events. There is good evidence that conventional treatments for heart failure, including ACE inhibitors, beta-blockers, aldosterone antagonists and cardiac resynchronisation devices reduce the risk of sudden death. Evidence that statins, aspirin or revascularisation are safe or effective in patients with heart failure is currently lacking. Implantable defibrillators confer a small but definite additional survival advantage by treating arrhythmias that have not been prevented.