Key result
Reduced left ventricular ejection fraction remains the primary indication for implantable cardioverter-defibrillators to prevent sudden cardiac death in ischemic heart disease, though novel predictors are needed.
This review summarizes the electrophysiological mechanisms of sudden cardiac death in ischemic heart disease and highlights the need for additional predictors beyond left ventricular ejection fraction for primary prevention ICD implantation.
LVEF remains the primary ICD indication in ischemic heart disease; leaves open identification of superior sudden death predictors.
Ischemic heart disease (IHD) and acute coronary syndrome are the main cause of sudden cardiac death (SCD). Incidence of SCD in patients after myocardial infarction (MI) is 4-6-fold higher than in general population. The review focuses on electrophysiological changes during acute myocardial ischemia and mechanisms of myocardial electromechanical remodeling in remote period after MI. Current data on arrhythmia substrates and triggers are presented. Nowadays, the main guide for implantable cardioverter-defibrillator (ICD) use for primary prevention of SCD is reduced left ventricular ejection fraction. The significance of this parameter has been repeatedly demonstrated in large randomized studies. However, the use of a single indicator cannot solve the problem. In this review we present analysis of modern additional predictors of fatal arrhythmias which are available in clinical practice, as well as the perspective for further research of this highly important scientific, clinical, and social problem.
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Голухова et al. (2017) conducted a review in Ischemic heart disease and sudden cardiac death. Implantable cardioverter-defibrillator (ICD) and risk stratification was evaluated. Reduced left ventricular ejection fraction remains the primary indication for implantable cardioverter-defibrillators to prevent sudden cardiac death in ischemic heart disease, though novel predictors are needed.
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