Prevention of sudden death in patients with coronary artery disease: The multicenter unsustained tachycardia trial (MUSTT)

Buxton, Alfred E.; Fisher, John D.; Josephson, Mark E.; Lee, Kerry L.; Pryor, David B.; Prystowsky, Eric N.; Simson, Michael B.; DiCarlo, Lorenzo A.; Echt, Debra S.; Packer, Douglas L.; Greer, G. Stephen; Talajic, Mario

doi:10.1016/0033-0620(93)90015-6

Cited by 519 publications

(602 citation statements)

References 26 publications

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“…[2][3][4] In addition, ICD therapy improves survival in high-risk patients who had never previously experienced a sustained ventricular tachyarrhythmia. 5,6 Thus, ICD treatment is becoming an increasingly important factor, both for the primary and the secondary prevention of sudden cardiac death.…”

Section: Introductionmentioning

confidence: 99%

Panic disorders and agoraphobia: Side effects of treatment with an implantable cardioverter/defibrillator

Godemann

Butter

Lampe

et al. 2004

Clinical Cardiology

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SummaryBackground: Implantable cardioverter/defibrillator (ICD) treatment has reduced the mortality of patients with a high risk of sudden cardiac death. However, ICD discharges may cause anxiety with respect to new discharges and lead to preventive, for example, phobic, behavior. This study evaluated the frequency of panic disorders and agoraphobia in patients with ICD and assessed the risk factors in their development.Hypothesis: Treatment with ICD represents a risk factor in the development of anxiety disorders.Methods: Ninety patients with ICD were examined using a standardized lifetime Diagnostic Interview of Psychiatric Syndromes (DIPS). This interview makes it possible to estimate the incidence of panic disorders and agoraphobia. The impact of the severity of the underlying cardiac disease, the number of ICD discharges, and the subjective appraisal of the shock experience on the development of panic disorders and agoraphobia was assessed.Results: Fifteen patients (16.7%) developed anxiety disorders after ICD implantation. The incidence was 21% in patients with and 6.9% in patients without ICD discharge. In patients with two or more ICD discharges annually, the incidence of panic disorders and agoraphobia was higher than

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Section: Introductionmentioning

confidence: 99%

Panic disorders and agoraphobia: Side effects of treatment with an implantable cardioverter/defibrillator

Godemann

Butter

Lampe

et al. 2004

Clinical Cardiology

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“…Despite over two decades of federal and industrial support for the evaluation of several hundred compounds, there are few antiarrhythmic drugs that reduce SCD incidence, even in high-risk pathologies. In contrast, the implantable cardioverter-defibrillator (ICD) is a proven therapy in preventing SCD in HF populations [6][7][8][9]. These devices, however, are expensive requiring medical resources not readily available to many segments of the population.…”

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confidence: 99%

Genomics, heart failure and sudden cardiac death

Darbar

2008

Heart Fail Rev

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Sudden cardiac death (SCD) is among the most common causes of death in developed countries throughout the world. Despite decreased overall cardiac mortality, SCD vrates appear to be increasing in concert with escalating global prevalence of coronary disease and heart failure, the two major conditions predisposing to SCD. This unfavorable trend is a consequence of our inability to identify those who will die suddenly from lethal ventricular arrhythmias and to develop effective therapies for all populations at risk. The known risk factors for SCD lack the predictive power needed to generate preventive strategies for the large number of fatal arrhythmic events that occur among lowerrisk subsets of the population. Even among recognized high-risk subsets, prediction of SCD remains challenging. With the exception of the implantable cardioverter defibrillator (ICD) there are few effective strategies for the prevention and treatment of SCD. This article discusses the prospect of genomic science as an approach to the identification of patients at high-risk for SCD. While the final common pathway for SCD is malignant ventricular arrhythmias, there are many potential contributors, pathways, and mechanisms by which common genetic variants (polymorphisms) could affect initiation and propagation of life-threatening cardiac arrhythmias. Recent advances in genomic medicine now provide us with novel approaches to both identify candidate genes/pathways and relatively common polymorphisms which may predispose patients to increased risk for SCD. Improved understanding of the relationship between common polymorphisms and SCD will not only improve risk stratification such that ICDs can be targeted to those patients most likely to benefit from them but also provide new insight into the pathophysiology of SCD. KeywordsSudden cardiac death; Genomics; Heart failure; Single nucleotide polymorphisms Heart failure and SCD Heart failure (HF) afflicts approximately 5 million people in the United States, with 550,000 new cases reported annually, but as the population ages both the incidence and prevalence is expected to rise [1]. HF is associated with high mortality and is reportedly responsible for 300,000 deaths annually in the US [1]. Prior to advent of neuro-hormonal antagonists, the mean duration of survival after onset of HF was 1.7 years for men and 3.2 years for women, with only half of patients still alive after 5 years of onset [2]. The two modes of death in patients with HF are circulatory failure due to progressive left ventricular (LV) dysfunction associated with gradual worsening of symptoms, or sudden cardiac death (SCD) in relatively clinically stable patients [3].Although the proportion of sudden deaths in published trials varies significantly, probably due to varying interpretations of reported modes of death, clinical trials data suggests that SCD accounts for approximately one-third of all HF deaths [4]. Epidemiologic evidence from the Framingham heart study suggests that about one-half of all deaths due to HF occur...

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“…Várias séries clínicas e diversos ensaios prospectivos randomizados demonstraram, de forma convincente, que em casos selecionados o cardioversordesfibrilador implantável é superior aos fármacos antiarrítmicos na redução da morte súbita cardíaca e na melhora da sobrevida [471][472][473][474][475][476] .…”

Section: -Taquicardia Ventricular Monomórfica Sustentadaunclassified

Diretrizes

2009

Arq. Bras. Cardiol.

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-Atendimento pré-hospitalarO interesse no atendimento pré-hospitalar do infarto agudo do miocárdio (IAM) teve início na década de 1960, devido ao grande número de óbitos que ocorriam antes que os paciente chegassem ao hospital.A maioria das mortes por IAM ocorre nas primeiras horas de manifestação da doença, sendo 40%-65% dos casos na primeira hora e, aproximadamente, 80% nas primeiras 24 horas [1][2][3] . Assim, a maior parte das mortes por IAM acontece fora do ambiente hospitalar, geralmente desassistidas pelos médicos 4 . A modalidade mais frequente de parada cardiorrespiratória nas primeiras horas do IAM é a fibrilação ventricular 3 . -Período pré-hospitalar.O período pré-hospitalar compreende dois momentos: a) do início dos sintomas (geralmente dor torácica aguda) até a decisão de procurar atendimento; b) da decisão de procurar atendimento até a chegada ao hospital.No infarto agudo do miocárdio com elevação do segmento ST (IAMCST), o tempo desde o início dos sintomas (oclusão da artéria coronária) até a instituição do tratamento (reperfusão química ou mecânica) é diretamente proporcional à ocorrência de eventos clinicamente relevantes. Esse tempo é fator fundamental para o benefício do tratamento, tanto imediato quanto tardio 5 .No entanto, sabe-se que a fase pré-hospitalar (em ambos os momentos descritos) é caracterizada por ser demorada, especialmente em pacientes idosos, do sexo feminino e com baixa condição socioeconômica 4 . Alguns fatores estão relacionados ao aumento desse tempo tão precioso (Quadro 1.1.1.1) 6 . O componente pré-hospitalar no atraso do atendimento ao paciente com dor torácica é de tal magnitude que, na prática clínica, apenas cerca de 20% destes pacientes chegam ao setor de emergência com até duas horas após o início dos sintomas 7 . -Medidas na fase pré-hospitalarApesar da significativa redução da mortalidade hospitalar do IAM nas últimas décadas 8,9 , houve pouco avanço no conhecimento sobre a epidemiologia e o tratamento na fase pré-hospitalar. É notória a necessidade de mudanças nesse cenário, embora poucas sejam as evidências geradas para este fim.A abordagem do paciente com suspeita de síndrome coronária aguda em ambiente extra-hospitalar deve, idealmente, ser feita por profissional de saúde, com realização de uma história clínica direcionada, investigando as características dos sintomas atuais (momento do início, tempo de duração, qualidade, intensidade, relação com o esforço e repouso) e a presença de doença coronária estabelecida (angina prévia). Algumas características são reconhecidamente determinantes para a manifestação atípica de um evento coronariano e devem ser lembradas quando um indivíduo for abordado na fase pré-hospitalar, por mascararem o quadro de IAM (Tabela 1.1.2.1) [10][11][12] .O eletrocardiograma executado no local de atendimento e interpretado por um médico habilitado (na ambulância ou em local remoto) mostrou ser um método que reduz em 34% o tempo porta-agulha e em 18% o tempo porta-balão, além de proporcionar maiores taxas de tempo porta-balão ideal (men...

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Prevention of sudden death in patients with coronary artery disease: The multicenter unsustained tachycardia trial (MUSTT)

Cited by 519 publications

References 26 publications

Panic disorders and agoraphobia: Side effects of treatment with an implantable cardioverter/defibrillator

Panic disorders and agoraphobia: Side effects of treatment with an implantable cardioverter/defibrillator

Genomics, heart failure and sudden cardiac death

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