Results of Expert MeetingsPreventing tomorrow's sudden cardiac death today: Part I: Current data on risk stratification for sudden cardiac death
Section snippets
Assessment of SCD risk: general considerations
One important challenge in studying SCD and its prevention lies in the accurate identification of the event. The definitions of SCD that are most commonly used are necessarily operational and take account of the limited and often circumstantial nature of the evidence available for the task. In addition, SCD is not a homogeneous pathophysiologic entity, but it is the final phenotypic manifestation of a number of unrelated disorders. These 2 factors alone introduce significant difficulties into
Assessment of SCD risk: specific tests and strategies
Several risk assessment strategies for SCD were discussed at the meeting. Data on these strategies are detailed below.
Role of the National ICD Registry
When the Centers for Medicare Services (CMS) officials issued the National Coverage Determination on January 27, 2005, to expand coverage for ICD implantation for the primary prevention of SCD, they mandated that data on all such implants in Medicare beneficiaries be entered in a National ICD Registry. The main goal of CMS for the Registry was to determine whether Medicare beneficiaries who meet the clinical criteria identified in the agency's National Coverage Determination derive benefit from
Future studies
Future efforts should focus on examining existing and novel markers in patients with ischemic and nonischemic heart disease to identify those who are more likely to benefit from an ICD. Markers that deserve attention include TWA, measures of cardiac autonomic modulation, QT variability, scar characteristics via MRI, and genetic and serum markers. Some of these markers are being examined in the National Institutes of Health–funded MADIT-II risk stratification substudy. This study will enroll 792
Conclusions
Although many tests of SCD vulnerability have been examined in patients with ischemic heart disease, current data do not support the consistent use of any test, other than the LVEF, to risk-stratify these patients. Efforts should focus on examining existing and novel markers in patients meeting the inclusion criteria of published clinical trials of ICD therapy to identify those who will benefit from an ICD. In that regard, risk modeling will likely be needed. Whether predictors differ
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2019, Computer Methods and Programs in BiomedicineHeart rate deceleration runs for postinfarction risk prediction
2012, Journal of ElectrocardiologyCitation Excerpt :Nevertheless, prospective identification of such patients remains challenging. The presently established “criterion standard” stratification of high-risk patients uses solely left ventricular ejection fraction that is neither particularly specific nor sensitive.3-10 The improvement of the precision with which patients at high risk of SCD can be identified thus presents an unmet clinical need.
Myocardial fibrosis predicts appropriate device therapy in patients with implantable cardioverter-defibrillators for primary prevention of sudden cardiac death
2011, Journal of the American College of CardiologySudden Cardiac Death: Epidemiology, Circadian Variation, and Triggers
2011, Current Problems in CardiologyCitation Excerpt :Another known risk factor for SCD is severe left ventricular dysfunction. Currently, severe left ventricular dysfunction—whether in the presence or absence of CAD—is the most reliable predictor for SCD and, in addition, is relatively easy to assess.23 The first report identifying left ventricular ejection fraction as a strong predictor for SCD in postinfarction patients dates back to 1983.24
This conference was funded by AstraZeneca, Bayer, Boston Scientific, Cambridge Heart Inc, Medtronic, Reliant Pharmaceuticals, St Jude Medical.