1、Sudden Cardiac Death: Prevention and Treatment Lexin Wang, M.D., Ph.D.Professor of Clinical PharmacologyHead, Cardiovascular Research Incidence of SCD SCD (caused by sudden cardiac arrest) is the most common cause of death in Western societies Incidence: 300,000 to 400,000 each year (U.S.) only 2% 1
2、5% reach the hospital Half of these early survivors die before dischargeRisk Factors of SCD Left ventricular failureCHD, cardiomyopathy Sudden cardiac death syndromesLong QT syndromes Brugada syndromePolymorphic catecholaminergic VTIsolated ventricular fibrillation CAD has become a main cause of SCD
3、80%CAD15% cardiomyopathy5% other*Huikuri HV. N Engl J Med. 2001;345:1473-1482.Myerburg RJ. Heart Disease, A Textbook of Cardiovascular Medicine. 6th ed. W.B. Saunders, Co. 2001.*ion-channel abnormalities, valvular or congenital heart disease, other causesBays de Luna A. Am Heart J. 1989;117:151-159.
4、Bradycardia 17%Monomorphic VT62% Primary VF 8%TdP 13%Prevalence of arrhythmia at SCDHeart Failure and SCD More than one million new heart failure patients every year in the USA25% mortality in 2.5 years in moderate to severe CHFA total of 15% of CHF patients die of SCD Gorgels, PMA. Eur Heart J .200
5、3;24:1204-1209.LVEF% SCD Victims7.5%5.1%2.8%1.4%LVEF and SCDCauses of deaths in HF: mainly SCD in NYHA II-III, heart failure in NYHA IVMERIT-HFStudy Group. LANCET. 1999;353:2001-2007.NYHA Class III n = 103NYHA Class II n = 103NYHA Class IV n = 2764%12%24%11%56%33%59%15%26% Myocardial infarction and
6、SCDAcute phase: ischemia-provoked VF; or mechanical dysfunctions (e.g. ventricular or papillary rupture)Chronic phase: structural remodelling of the LV, leading to re-entry or heart failure Risk stratification of SCD Risk assessmentClinical dataAetiology; family history; LVEFEPST wave alternansQT dispersionArrhythmia during Holter monitoring or stress test
