Sudden Cardiac Death

Nam-Ho Kim; Kyeong Ho Yun; Seok Kyu Oh

doi:10.5124/jkma.2010.53.3.214

J Korean Med Assoc > Volume 53(3); 2010 > Article

Kim, Yun, and Oh: Sudden Cardiac Death

Focused Issue of This Month

Treatment of Heart Disease

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2010; 53(3): 214-227.

Published online: March 31, 2010

DOI: http://dx.doi.org/10.5124/jkma.2010.53.3.214

Sudden Cardiac Death

Nam-Ho Kim, MD, Kyeong Ho Yun, MD, Seok Kyu Oh, MD

Department of Interal Medicine, Wonkwang University College of Medicine, Korea. cardionh@wonkwang.ac.kr

Abstract

Sudden cardiac death (SCD) refers to the unexpected natural death from a cardiac cause within a short time period, generally within an hour from the onset of symptoms, in a person without any prior fatal condition. Despite the tremendous advances in the field of cardiovascular medicine, the incidence of SCD continues to rise. In 60 to 80 percent of cases, SCD occurs in the patients with coronary artery disease. Most instances of SCD are thought to involve ventricular tachycardia degenerating to ventricular fibrillation and subsequent asystole. Since the implantable cardioverter defibrillator (ICD) is effective in terminating ventricular tachycardia and fibrillation, the application of ICD has increased markedly. However, the application of ICD needs to be individualized for the patient, similar to drug therapies in LV systolic dysfunction. This review discusses the current understanding on SCD, risk stratification, and management goals for reducing SCD, particularly with the ICD usage.

Sudden cardiac death; Coronary artery disease; Left ventricular ejection fraction; Implantable cardioverter defibrillator

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Figure 1

The pathogenesis of sudden cardiac death. Structural cardiac abnormalities are commonly defined as the causative basis for sudden cardiac death. However, functional alterations of the abnormal anatomical substrates are usually required to alter stability of the myocardium, permitting a potentially fatal arrhythmia to be initiated.

Figure 2

Prevention of sudden cardiac death. The identification and control of atherosclerotic risk factors are important to prevent the sudden cardiac death.

CAD: coronary artery disease, SCD: sudden cardiac

Table 1

Summary of noninvasive risk-stratification techniques for identifying patients with coronary artery disease who are at risk for sudden cardiac death.

HRV: heart rate variability, NSVT: non-sustained ventricular tachycardia, SCD: sudden cardiac death

Table 2

Summary of estimated incidence, relative risks and proposed therapies for ventricular arrhythmias post-myocardial infarction

Table 3

Primary prevention of sudden cardiac death in ischemic or non-ischemic cardiomyopathy with implantable cardioverter defibrillator.