Sudden Cardiac Death: Management of High-Risk Patients

1991 ◽  
Vol 114 (6) ◽  
pp. 499 ◽  
Author(s):  
Masood Akhtar
Keyword(s):  
High Risk ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Updating the Risk Stratification for Sudden Cardiac Death in Cardiomyopathies: The Evolving Role of Cardiac Magnetic Resonance Imaging. An Approach for the Electrophysiologist

Diagnostics ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 541 ◽  
Author(s):  
Ourania Kariki ◽  
Christos-Konstantinos Antoniou ◽  
Sophie Mavrogeni ◽  
Konstantinos A. Gatzoulis
Keyword(s):  
Cardiac Magnetic Resonance ◽  
High Risk ◽  
Sudden Cardiac Death ◽  
Magnetic Resonance ◽  
Cardiac Death ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
High Risk Patients ◽  
Risk Patients

The prevention of sudden cardiac death (SCD) in cardiomyopathies (CM) remains a challenge. The current guidelines still favor the implantation of devices for the primary prevention of SCD only in patients with severely reduced left ventricular ejection fraction (LVEF) and heart failure (HF) symptoms. The implantation of an implantable cardioverter-defibrillator (ICD) is a protective barrier against arrhythmic events in CMs, but the benefit does not outweigh the cost in low risk patients. The identification of high risk patients is the key to an individualized prevention strategy. Cardiac magnetic resonance (CMR) provides reliable and reproducible information about biventricular function and tissue characterization. Furthermore, late gadolinium enhancement (LGE) quantification and pattern of distribution, as well as abnormal T1 mapping and extracellular volume (ECV), representing indices of diffuse fibrosis, can enhance our ability to detect high risk patients. CMR can also complement electro-anatomical mapping (EAM), a technique already applied in the risk evaluation and in the ventricular arrhythmias ablation therapy of CM patients, providing a more accurate assessment of fibrosis and arrhythmic corridors. As a result, CMR provides a new insight into the pathological substrate of CM. CMR may help identify high risk CM patients and, combined with EAM, can provide an integrated evaluation of scar and arrhythmic corridors in the ablative therapy of ventricular arrhythmias.

scholarly journals Predictors of sudden cardiac death in high‐risk patients following a myocardial infarction

2020 ◽  
Vol 22 (5) ◽  
pp. 848-855 ◽  
Author(s):  
Kieran F. Docherty ◽  
João Pedro Ferreira ◽  
Abhinav Sharma ◽  
Nicolas Girerd ◽  
John Gregson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals A novel research platform for sudden cardiac death based on continuous, real-life, unlimited follow-up of a cohort of high-risk patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S.B Boveda ◽  
Keyword(s):  
High Risk ◽  
Sudden Cardiac Death ◽  
Doctoral Students ◽  
Cardiac Death ◽  
Real Life ◽  
Preventive Strategies ◽  
High Risk Patients ◽  
Research Platform ◽  
Risk Patients

Abstract Background/Introduction Currently, Sudden Cardiac Death (SCD) prevention is mainly based on implantable cardioverter-defibrillator (ICD) implantation in high risk patients. Real-time, prospective follow-up of such high-risk patients can afford a unique opportunity to improve SCD prevention. We previously conducted an exploratory retrospective project (DAIPP pilot program) focusing on >5 000 ICD recipients, which provided us with valuable information and knowledge to set up a wider, prospective project (1–11). Purpose We present here the organizational outline for an innovative research platform for SCD, based on a real-life cohort with continuous, unlimited follow-up. The overall aim is to garner high-value information which can help optimize individualized risk stratification, cardiac defibrillation, and preventive strategies to eventually decrease SCD burden. Methods and results The DAIPP Consortium is an investigator-initiated, prospective, multicentre, independent, long-term, academic cohort study, focusing on patients at high risk of SCD and implanted with an ICD. More than 5 000 ICD recipients will be enrolled prospectively and consecutively through 17 French tertiary public and private hospitals during the first three years. All patients will be monitored continuously through a unique remote monitoring platform, and they will be linked to the national “Health Data Hub”, gathering information about medications, hospitalizations and outcomes. Quality and exhaustivity of the collected data will be regularly monitored through systematic monthly automatic indices in each center. Events will be centrally adjudicated. For the 2021–2023 period, 6 work-packages have already been created within the research platform, some being clinical and others translational research, including ischemic cardiomyopathy, new technologies, congenital cardiomyopathies, channelopathies, complications and artificial intelligence, to develop new approaches. Concomitantly, the consortium will be open to external collaborations, and an academic research program has been initiated with various European universities to enable Master, PhD and Post-doctoral students to conduct their research on SCD. Conclusion DAIPP is an investigator-initiated real-life continuous follow-up cohort of patients at high risk of SCD. This project will provide an open research platform to enhance the understanding of, and improve preventive strategies for SCD. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): Inserm, Société Française de Cardiologie, Clinique Pasteur

Predictors of sudden cardiac death and ventricular tachyarrhythmias in patients with hypertrophic cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Rineiska ◽  
E Zakharava ◽  
S Komissarova ◽  
I Haidel
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
High Risk ◽  
Sudden Cardiac Death ◽  
Myocardial Fibrosis ◽  
Cardiac Death ◽  
T1 Mapping ◽  
Adverse Outcome ◽  
Low Risk ◽  
Ventricular Tachyarrhythmias ◽  
Risk Patients

Abstract Background Determining additional predictors that allow more accurate identification of patients who need primary prevention of sudden cardiac death (SCD) and ventricular tachyarrhythmias (VT) in patients with hypertrophic cardiomyopathy (HCM) is one of the most important tasks. High-risk patients can be more accurately identified using modern non-invasive research methods. Purpose Identification of new risk predictors for SCD and ventricular tachyarrhythmias based on cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) and T1-mapping in patients with hypertrophic cardiomyopathy. Materials and methods Clinical data of 98 HCM subjects (58 males and 40 females, median age 46.5 [35.2; 54.7] treated in our centre in the period between 2013 and 2017 have been studied. All patients underwent CMR with LGE and T1-mapping. Results According to the existing ESC-2014 scale, 45 (46%) of the 98 patients included in the study had a low risk, an intermediate risk was identified in 26 (26%) patients and a high risk of SCD in 27 (28%). During the follow-up period 16 episodes of sudden cardiac death were recorded. Of these, only 8 (50%) patients had a high risk on the ESC-2014 scale. High-risk patients show significantly greater myocardial fibrosis (Me 28.5%; [21.9; 44.1]) compared with patients with intermediate (Me 17.6% [8.0; 22.5]) and low risk of SCD (Me 11.7%; [5.8; 17.6]), p<0.001. A threshold level of fibrosis volume associated with an adverse outcome was determined, which was 15% (based on determining the maximum rank of statistics). For patients with 15% fibrosis volume, the cumulative survival rate on the Kaplan-Mayer curve over the observation period was 96% (95% CI 88.6–100), while for patients with fibrosis volume ≥15% - 72.4% (95% CI 60.6–86.4). The study showed that in 15 (93.7%) patients out of 16 who had an adverse outcome, the volume of myocardial fibrosis was ≥15%. Episodes of nonsustained ventricular tachycardia were detected in 48 patients (48.7%) according to daily ECG monitoring. To identify patients with ventricular tachyarrhythmias by ROC analysis, the threshold value of extracellular myocardial volume was determined using CMR with LGE and T1 mapping, which was 32.5% (sensitivity 74% and specificity 86%). According to multivariate analysis, one of the independent predictors of ventricular tachyarrhythmias was the level of extracellular myocardial volume ≥32.5% (HR 1.2; 95% CI 1.03–1.4). Conclusion Predictors detected by CMR with LGE and T1 mapping can identify patients with HCM with a high risk of sudden cardiac death and ventricular tachyarrhythmias. Funding Acknowledgement Type of funding source: None

scholarly journals Sudden Cardiac Death in Chagas Disease

2016 ◽  
Vol 7 ◽  
Author(s):  
Dario Di Toro ◽  
Adrian Baranchuk
Keyword(s):  
High Risk ◽  
Sudden Cardiac Death ◽  
Effective Treatment ◽  
Chagas Disease ◽  
Cardiac Death ◽  
Implantable Cardioverter Defibrillators ◽  
Endemic Region ◽  
Arrhythmic Death ◽  
Risk Patients ◽  
Cardioverter Defibrillators

<p>Chagas’ disease remains a major epidemiologic problem in endemic countries. The most dramatic course of the disease is represented by sudden cardiac death. Some of these deaths could be preventable, if efforts are directed towards identifying high-risk patients. Implantable cardioverter-defibrillators are an effective treatment for the prevention of sudden cardiac arrhythmic death, however; its costs are the major limitation for their widespread use in the endemic region.</p><p>This review will cover some of the most relevant aspects of sudden cardiac death in Chagas’ disease. </p>

scholarly journals Effectiveness of the 2014 European Society of Cardiology guideline on sudden cardiac death in hypertrophic cardiomyopathy: a systematic review and meta-analysis

Heart ◽  
2018 ◽  
pp. heartjnl-2018-313700 ◽  
Author(s):  
Constantinos O’Mahony ◽  
Mohammed Majid Akhtar ◽  
Zacharias Anastasiou ◽  
Oliver P Guttmann ◽  
Pieter A Vriesendorp ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hypertrophic Cardiomyopathy ◽  
High Risk ◽  
Sudden Cardiac Death ◽  
European Society ◽  
Cardiac Death ◽  
Meta Analysis ◽  
Registration Number ◽  
Risk Patients ◽  
European Society Of Cardiology

ObjectiveIn 2014, the European Society of Cardiology (ESC) recommended the use of a novel risk prediction model (HCM Risk-SCD) to guide use of implantable cardioverter defibrillators (ICD) for the primary prevention of sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). We sought to determine the performance of HCM Risk-SCD by conducting a systematic review and meta-analysis of articles reporting on the prevalence of SCD within 5 years of evaluation in low, intermediate and high-risk patients as defined by the 2014 guidelines (predicted risk <4%, 4%–<6% and ≥6%, respectively).MethodsThe protocol was registered with PROSPERO (registration number: CRD42017064203). MEDLINE and manual searches for papers published from October 2014 to December 2017 were performed. Longitudinal, observational cohorts of unselected adult patients, without history of cardiac arrest were considered. The original HCM Risk-SCD development study was included a priori. Data were pooled using a random effects model.ResultsSix (0.9%) out of 653 independent publications identified by the initial search were included. The calculated 5-year risk of SCD was reported in 7291 individuals (70% low, 15% intermediate; 15% high risk) with 184 (2.5%) SCD endpoints within 5 years of baseline evaluation. Most SCD endpoints (68%) occurred in patients with an estimated 5-year risk of ≥4% who formed 30% of the total study cohort. Using the random effects method, the pooled prevalence of SCD endpoints was 1.01% (95% CI 0.52 to 1.61) in low-risk patients, 2.43% (95% CI 1.23 to 3.92) in intermediate and 8.4% (95% CI 6.68 to 10.25) in high-risk patients.ConclusionsThis meta-analysis demonstrates that HCM Risk-SCD provides accurate risk estimations that can be used to guide ICD therapy in accordance with the 2014 ESC guidelines.Registration numberPROSPERO CRD42017064203;Pre-results.

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