Sudden cardiac death: We are not there yet

Abstract

Sudden cardiac death (SCD) remains the leading cause of mortality in developed nations, despite significant advances over the past half-century [1]. Major practice-changing advances have included improved identification of coronary artery disease (CAD) risk factors, aggressive prevention of CAD, improved treatment of acute coronary syndromes (ACS), recognition of some rare but high-risk genetic causes of ventricular arrhythmias (VAs), and the use of implantable cardioverter–defibrillators (ICDs). Significant impacts also have been made by the presence of automated external defibrillators in public places, and large public educational campaigns on basic and advance cardiopulmonary resuscitation. In this issue of the Journal, Mitrani and Myerburg [2] have comprehensively but concisely described recent developments in the understanding, prevention, and treatment of SCD. These developments range widely in their context, and include changes in the definition of SCD, recognition of epidemiologic trends, the evolution of SCD mechanisms, and developments in specific clinical conditions, genetic mutations, or polymorphisms. The authors also discuss the increasing recognition of the intricacies of post-cardiac arrest care, which should differ based on the duration of the arrest, i.e., time elapsed before the return of spontaneous circulation. The aim of this brief editorial is to place these developments in the overall context of where we are in the identification of risk, prevention, and treatment of SCD, and where we need to be, to make an impact on this enigmatic societal problem.