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L A Bokeria1, N M Neminushchiy, A S Postol
1Sechenov First Moscow State Medical University. fake@neicon.ru.
Insights
Preventing sudden cardiac death with implantable cardioverter-defibrillators is improving. New methods like myocardial imaging and medical genetics help better select patients for defibrillator implantation, enhancing prevention strategies.
Area of Science:
- Cardiology
- Medical Devices
- Preventive Medicine
Background:
- Sudden cardiac death (SCD) remains a significant clinical challenge.
- Current primary prevention strategies for SCD using implantable cardioverter-defibrillators (ICDs) rely on heart failure severity and left ventricular dysfunction, which have limitations.
- These limitations include low predictive accuracy and the need for widespread ICD implantation, increasing risks and costs.
Purpose of the Study:
- To review the historical development of ICDs for SCD prevention.
- To evaluate the effectiveness and limitations of current SCD prevention concepts.
- To explore how advancements in myocardial imaging and medical genetics can refine ICD implantation criteria.
Main Methods:
- Literature review of ICD development and application in SCD prevention.
- Analysis of current guidelines and clinical practices for primary SCD prevention.
- Discussion of emerging technologies for myocardial assessment and genetic profiling.
Main Results:
- The efficacy of ICDs in primary SCD prevention is challenged by the suboptimal accuracy of existing criteria.
- Myocardial fibrosis assessment through advanced imaging techniques offers a more precise method to identify at-risk individuals.
- Medical genetics provides complementary data for risk stratification in SCD prevention.
Conclusions:
- Refining ICD implantation indications is crucial for optimizing SCD prevention.
- Integrating myocardial imaging and genetic analysis can significantly improve patient selection for ICDs.
- These advancements promise to enhance the overall concept and effectiveness of SCD prevention strategies using ICDs.
Abstract:
The article covers the development of the problem of sudden cardiac death prevention with the implantable cardioverter-defibrillators from the moment of creation of these devices to our days. The current concept of primary prevention of sudden cardiac death, based on the severity of manifestation of heart failure and left ventricular dysfunction, is not effective enough. Its practical application is difficult because it requires mass application of implantable defibrillators, with low predictive accuracy of these criteria in terms of development of life-threatening arrhythmias. The development of methods for visualizing the myocardium, allowing to assess the severity of myocardial fibrosis, as well as the possibilities of medical genetics, at the present stage, allows us to clarify indications for implantation of cardioverter-defibrillators and thereby significantly improve the concept of preventing sudden cardiac death with these instruments.