Key result
Post-infarction sudden cardiac death prevention requires multifaceted strategies stratified primarily by LVEF severity.
Why the study?
While the implantable cardioverter-defibrillator is the logical management for survivors of sudden cardiac death, preventing a first cardiac arrest in patients with advanced structural disease due to CAD requires a realistic, cost-effective, and multifaceted approach.
Preventing a first sudden cardiac arrest requires a cost-effective, multifaceted approach focusing on infarct size limitation, post-MI medical therapy (aspirin, beta-blockers, ACE inhibitors, amiodarone), and appropriate selection for ICD or transplantation based on LVEF (<35% vs <15-20%).
Answers are grounded in this paper and cite their sources.
LVEF-guided selection may inform post-MI SCD prevention choices; leaves open prospective validation of multifaceted strategies.
Sudden cardiac death (SCD) is usually due to monomorphic ventricular tachycardia and/or ventricular fibrillation. However, in the vast majority of patients these arrhythmias are associated with advanced structural disease. In our society, this is usually due to coronary artery disease (CAD). The implantable cardioverter--defibrillator is the logical approach to management in survivors of SCD. Its rational use must be guided by electrophysiology study. However, a realistic and cost-effective approach to the prevention of a first cardiac arrest must be multifaceted and take cognisance of other aspects including primary prevention. Limitation of the size of myocardial infarction (MI) is vital. Trials already suggests that effective thrombolysis may impinge long-term on arrhythmic end-points. Following infarction, ventricular arrhythmias and sudden death may also be decreased by aspirin, beta-blockers, and possibly angiotensin converting enzyme inhibitors and amiodarone. Many post-infarction studies employ a combined end-point of death and clinical arrhythmias. However, death is usually confined to those with an ejection fraction < 35%. In them, treatment of associated heart failure is often a consideration and if the ejection fraction < 15-20%, depending on donor availability, transplantation may even be the preferred therapeutic option to the cardioverter-defibrillator.
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Andrew Maxwell Tonkin (1992) conducted a review in Sudden cardiac death and post-myocardial infarction ventricular arrhythmias. Implantable cardioverter-defibrillator (ICD), thrombolysis, aspirin, beta-blockers, ACE inhibitors, amiodarone, and cardiac transplantation was evaluated on Sudden cardiac death and clinical ventricular arrhythmias. Prevention of sudden cardiac death requires a multifaceted approach, as post-infarction death is usually confined to patients with LVEF <35% and transplantation may be preferred if LVEF is <15-20%.
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