Sudden cardiac death of patients with coronary artery disease and implantable cardioverter- defibrillator – a need for further risk stratification?

Abstract

Implantation of cardioverter-defibrillator is a «gold standard» procedure for sudden cardiac death prevention in a high risk group of patients with coronary artery disease. Population of patients with an implantable cardioverter-defibrillator is growing. According to increasing knowledge about natural history of patients with implantable cardioverter-defibrillator, risk of sudden cardiac death in this group is still significant. In big trials there are about 1,5–3,5% of patients with implantable cardioverter-defibrillator dying from sudden cardiac death. In this issue, current studies and future directions of sudden cardiac death stratification in patients with implantable cardioverter-defibrillator are discussed. Implantable cardioverter-defibrillator shock is known to be a negative risk factor of sudden and all-cause mortality. Ventricular tachycardia or ventricular fibrillation can be the direct mechanism of sudden cardiac death or increase non-sudden cardiac death incidence by negative effects on myocardium of implantable cardioverter-defibrillator shocks. Risk factors and risk stratification systems of life-threating ventricular arrhythmias have a potential for wide clinical usage. An early or preventive antiarrhythmic therapy in high risk group can decrease sudden and all-cause mortality in patients with implantable cardioverter-defibrillator and make this therapy more effective.

Keywords

sudden cardiac death / implantable cardioverter-defibrillator / coronary artery disease / ventricular tachycardia / ventricular fibrillation / implantable cardioverter-defibrillator shock / myocardial infarction

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