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Tachycardia-Induced Cardiomyopathy As a Chronic Heart Failure Model in Swine

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Published on: February 17, 2018

Sudden cardiac death in patients with chronic coronary heart disease

J L Hurwitz¹, M E Josephson

¹Clinical Electrophysiology Laboratory, Hospital of the University of Pennsylvania, Philadelphia 19104.

|January 1, 1992

Insights

Sudden cardiac death (SCD) affects 300,000-400,000 annually. Identifying inducible ventricular tachycardia via electrophysiological study is key for managing SCD recurrence risk.

Area of Science:

Cardiology
Electrophysiology
Sudden Cardiac Death Research

Background:

Sudden cardiac death (SCD) causes 300,000-400,000 deaths yearly, with a 40% recurrence rate in survivors within 2 years.
Coronary artery disease, particularly with left ventricular dysfunction, is a primary risk factor, though SCD can be the initial presentation.
Ventricular tachycardia is the most common arrhythmic cause of SCD, often linked to slowed conduction in damaged ventricles.

Purpose of the Study:

To investigate the predictors and management strategies for sudden cardiac death (SCD) and its recurrence.
To evaluate the role of electrophysiological studies in identifying patients at risk for SCD.
To assess the effectiveness of pharmacological and surgical interventions in preventing SCD recurrence.

Main Methods:

Analysis of endocardial mapping during electrophysiological studies in SCD patients.
Assessment of left ventricular function and signal-averaged electrocardiograms as predictors.
Evaluation of inducible ventricular tachycardia and patient response to antiarrhythmic drugs or interventions.

Main Results:

Poor left ventricular function is a better predictor of SCD recurrence than complex ventricular ectopy.
Electrophysiological studies reveal slowed conduction in SCD patients with ventricular damage.
Pharmacological rendering of noninducible ventricular tachycardia improves prognosis; persistent inducibility or non-inducibility indicates high recurrence risk.

Conclusions:

Electrophysiological study is crucial for risk stratification in sudden cardiac death (SCD).
Patients with inducible ventricular tachycardia who become noninducible with medication have a favorable prognosis.
High-risk patients may benefit from subendocardial resection or implantable defibrillators to prevent SCD recurrence.

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Abstract:

Sudden cardiac death (SCD) is responsible for 300,000-400,000 deaths per year with a recurrence rate of up to 40% in survivors within the first 2 years. SCD often occurs in patients with chronic coronary artery disease, which is manifested by myocardial infarction and left ventricular dysfunction but is infrequently associated with acute infarction. SCD may be the initial symptom of coronary artery disease. Primary or rapid ventricular tachycardia are the most common arrhythmic causes of SCD. Endocardial mapping studies during electrophysiological study have shown areas of slowed conduction with abnormal endocardial electrograms in SCD patients with moderately damaged ventricles. SCD increases with age and occurs more frequently in men with coronary artery disease as a significant risk factor. Complex ventricular ectopy, once thought of as an independent risk factor, is not as good a predictor as poor left ventricular function for recurrence of SCD. While signal-averaged electrocardiograms can identify patients with slowed conduction, their positive predictive value for SCD is poor. Initial evaluation should be aimed at the identification of ischemia, since those patients with SCD and acute myocardial infarction do well when treated for their ischemia. The arrhythmias that are inducible during electrophysiological study are rapid and poorly tolerated. Patients with inducible ventricular tachycardia who are rendered noninducible pharmacologically have a good prognosis, whereas those who are still inducible or have no inducible arrhythmias have a high recurrence rate of SCD and should be considered for subendocardial resection when appropriate or for placement of an implantable defibrillator.

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