View Point – Sudden Cardiac Death

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Authors: Ram B Singh, Sergey Chibisov, Ghazi Halabi, Elena Kharlitskaya, and OA Bawareed
Page Range: 159-167
Published in: World Heart Journal, 15#3 (2023)
ISSN: 1556-4002

Table of Contents

ABSTRACT

Despite all the technological and medical advances of the 21st century, it is a fact that survival from sudden cardiac arrest (SCA) remains lower than 10% in most parts of the world. The Lancet Commission on SCD was constituted, bringing together 30 international experts in varied disciplines, recognizing this urgent need. In a recent study from Europe, the results revealed that the average annual incidence of SCD in the 4 registries ranged from 36.8 per 100,000 (95% CI: 23.5-50.1 per 100,000) to 39.7 per 100,000 (95% CI: 32.6-46.8 per 100,000). When extrapolating to each European country and accounting for age and sex, this yields to 249,538 SCD cases per year (95% CI: 155,377-343,719 SCD cases per year). The commonest cause of SCD appears to be coronary artery diseases (CAD) comprising 70% and the second common cause of SCD may be cardio-myopathies in 15%. Despite major investments by the medical and research communities over the past decades, the prognosis of out-of-hospital cardiac arrest (OHCA) continues to remain low with the highest overall 30-day survival of about 13%. Any inflammatory focus in the myocardium either due to acute increase in cortisol or myocardial ischemia may inhibit coordination of myocardial cells, resulting in ventricular fibrillation. It is interesting that mutations that compromised cardiomyocyte function invariably affect conduction. Treatment strategies include treat-ment of the underlying disease with lifestyle advice and drugs and decisions to implant a primary prev-ention implantable cardioverter-defibrillator (ICD) and perform ablation of the ventricles and novel treatment modalities such as left cardiac sympathetic denervation in rare specific primary electric diseases such as long QT syndrome and catecholaminergic polymorphic ventricular tachycardia.

Keywords: Sudden cardiac arrest, heart attack, ventricular fibrillation.

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