Predicting and Preventing Sudden Death From Cardiac Causes
作者:
James Gilman,
Sohail Jalal,
Gerald Naccarelli,
期刊:
Circulation
(OVID Available online 1994)
卷期:
Volume 90,
issue 2
页码: 1083-1092
ISSN:0009-7322
年代: 1994
出版商: OVID
关键词: sudden cardiac death;ventricular tachycardia;ventricular fibrillation;antiarrhythmic drugs;implantable cardioverter-defibrillators
数据来源: OVID
摘要:
AbstractSudden cardiac death usually occurs secondary to a ventricular tachyarrhythmia. Even under ideal circumstances only 20% of patients who have an out-of-hospital cardiac arrest survive to hospital discharge. Therefore, aggressive treatment and screening of high-risk patients are mandatory to improve survival rates. Risk stratification of high-risk patients, such as the post – myocardial infarction (M1) population, has been of limited value. Between 70% and 85% of “high-risk” post-MI patients, as defined by these screening tests, will not have a sustained ventricular tachyarrhythmia over several years of follow-up. The use of β-blockers and possibly amiod-arone may have some benefit in reducing mortality in high-risk patients after an MI. Several ongoing trials are studying the use of serial drug testing, amiodarone, and implantable cardioverter-defibrillators in reducing the incidence of sudden cardiac death in patients with potentially lethal ventricular arrhythmias. Although implantable cardioverter-defibrillators appear to be superior to antiarrhythmic drugs in reducing sudden cardiac death, total mortality may not be altered. In sustained ventricular tachyarrhythmias, sotalol and amiodarone appear to be superior to other drugs in preventing arrhythmia recurrence. Ongoing trials, such as the Antiar-rhythmic Drug versus Implantable Device (AVID) trial may define the best strategy in these high-risk patients.
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