Prognosis of ventricular arrhythmias in relation to sudden cardiac death: Therapeutic implications

Abstract

The hypothesis that ventricular arrhythmias represent an independent predictor of sudden cardiac death was examined by analyzing the published data. The frequency and complexity of ventricular arrhythmias increase progressively both with age and severity of heart disease, but no age- or disease-related norms have been established for clinical guidance. Simple and complex arrhythmias, including short runs of ventricular tachycardia, do not increase risk of sudden cardiac death in subjects without heart disease or with heart disease and normal myocardial function. Progression of nonsustained into sustained ventricular tachycardia in such individuals is rare. Simple and complex ventricular arrhythmias are not strong independent predictors of sudden death in survivors of myocardial infarction. In these, the overall incidence of sudden cardiac death averages 3.5 to 5% during the first year, but is about 15 to 20% per year in patients with severely impaired ventricular function. The results of this survey suggest that in patients with well preserved ventricular function, prophylactic use of antiarrhythmic drugs is not indicated, and that treatment of asymptomatic or mildly symptomatic ventricular arrhythmias is not likely to reduce the incidence of sudden cardiac death.

Predictors of sudden cardiac death in never previously treated patients with essential hypertension: long-term follow-up

“…12 In fact, in otherwise healthy subjects the occurrence of ventricular ectopy has little, if any, prognostic significance. 24,25 In contrast, in patients with documented heart disease ventricular ectopy has more serious prognostic implications. 26,27 The exact mechanism of ventricular arrhythmias in hypertensive patients with LVH is not clear.…”

Discordance in investigator-reported and adjudicated sudden death in TIOSPIR

“…In fact, sudden cardiac death is usually overestimated. Previous studies have confirmed that pre-existing coronary heart disease or congestive heart failure increase the risk of sudden death [15–17] and account for almost 75% of sudden cardiac deaths in the western world [18–20]. It is noteworthy that the deaths classified as sudden cardiac are often non-cardiac [21] and a significant proportion of out-of-hospital cardiac arrests in COPD patients is attributable to underlying lung disease [22].…”

Sudden cardiac death and the potential role of beta-adrenoceptor-blocking drugs

“…65 The main cause of death is ventricular tachycardia which leads to ventricular fibrillation. Those patients with markedly reduced ventricular systolic and diastolic function are particularly vulnerable.…”