Diagnosis and management of sudden cardiac death

udden cardiac death (SCD) is an enormous public health problem with at least 300 000 deaths per year in the USA alone. The current state-of-the-art for treatment of SCD has several significant limitations. Because ventricular fibrillation (VF) quickly becomes irreversible, successful treatment requires immediate care. Even in metropolitan areas with excellent emergency medical services, survival of out-of-hospital cardiac arrest is extremely low. Attempts to prevent SCD with antiarrhythmic agents have had little success (and in some cases increased mortality). The development of implantable cardioverter-defibrillators (ICDs), which detect and treat VF almost instantly, has revolutionised the treatment of SCD. However, to be effective these devices must be implanted before cardiac arrest. This is the source of one of the major dilemmas in current SCD management: How to identify SCD victims before their first episode.