Development Of Sudden Cardiac Death Research Articles

The role of 3D speckle-tracking echocardiography in predicting long-term outcomes after a first myocardial infarction

Aim. To determine the role of 3D echocardiography parameters in the prognosis of long-term cardiovascular complications in patients with a first acute myocardial infarction (AMI).Materials and methods. А prospective, single-center, observational study included 46 patients with a first AMI and successful PCI without a history of heart failure (HF) and shortness of breath upon admission. The examination of patients was performed in accordance with the Russian standards of medical care provision. Additionally, 3D echocardiography was performed, and N-terminal pro-brain natriuretic peptide (NT-proBNP) was determined. The main outcomes assessed were hospitalization with HF, sudden cardiac death, and combined endpoint. Median follow-up was 554 days (IQR 550–785).Results. During the follow-up period, 9 hospitalizations with HF, 3 sudden cardiac deaths, and 12 combined endpoints were registered. The effect of 3D echocardiography parameters on the development of sudden cardiac death and combined endpoint has not been revealed. The effect of the studied parameters on the development of HF during the follow-up period that required hospitalization was evaluated. A statistically significant increase in the LV sphericity index was revealed in the group of patients with the registered outcome. We found significant direct correlations of left ventricular volume indices with prescription of diuretics in the post-discharge period; hospitalization with HF in the post-infarction period with the level of NT-pro-BNP, left atrial volume with the duration of index hospitalization, duration of eventless survival with ST elevation. We found a negative correlation of radial strain with prescription of diuretics in the post-discharge period. Predictors of hospitalization with HF in the post-infarction period were identified – parameters of radial strain, area strain, and circumferential strain, which were included in the model for calculating the risk of the outcome under study.Conclusion. In patients with the first AMI in the absence of clinical signs of HF, to calculate the risk of hospitalization with HF within 550 days after MI, it is advisable to take into account the level of radial strain and use a prognostic model (1), including parameters of circumferential and area strain (according to 3D echocardiography data).

ECG changes and their prognostic value for the development of sudden cardiac death in HCM patients

Background. Hypertrophic cardiomyopathy (HCM) is a primary myocardial disease characterized by an increase in the left ventricular (LV) wall thickness, which is not explained only by abnormal loading conditions. The development of sudden cardiac death (SCD) is one of the most dangerous complications of HCM. The aim of our study was to evaluate the prognostic value of electrocardiography (ECG) changes for the development of SCD in the Ukrainian population of patients with HCM. Materials and methods. We evaluated 350 patients with HCM who were examined in the City Clinical Hospital 8 (Kharkiv, Ukraine) from 2006 to 2021. The diagnosis of HCM was made in accordance with the current guidelines of the European Society of Cardiology. Clinical and instrumental data of patients with HCM were analyzed retrospectively, including general clinical data, 12-lead ECG, echocardiography, Holter monitoring, calculation of the 5-year risk of SCD according to the HCM Risk-SCD tool. The endpoint of the study was SCD and its surrogates, including adequate performance of the implantable cardioverter-defibrillator and the state after a successful resuscitation. Results. Follow-up was 5.0 (1.5–9.5) years. During this time, 16 patients (4.6 %) reached the endpoint, which was 0.9 %/year. According to the HCM Risk-SCD, 5 (31.3 %) patients in this group were at a high (≥ 6 %) and 3 (18.8 %) were at an intermediate risk of SCD (≥ 4 and < 6 %). A multivariable Cox regression analysis has shown that independent predictors of SCD are syncope (hazard ratio (HR) 3.81, 95% confidence interval (CI) 1.11–13.12, p = 0.034), systolic blood pressure (HR 0.97, 95% CI 0.94–0.99, p = 0.026), ECG with “infarction-like” ST elevation (HR 6.81, 95% CI 2.09–22.16, p = 0.001) and PQ interval value (HR 1.03, 95% CI 1.01–1.05, p = 0.002), Harrell’s C-index (HR 0.84, 95% CI 0.73–0.95, p < 0.0001). Conclusions. The proposed HCM Risk-SCD tool was not effective enough in predicting SCD in our study. In order to improve the risk stratification, ECG changes (“infarction-like” ST elevation and PQ interval prolongation) and systolic blood pressure lowering can be used, which were found to be independent predictors of SCD risk.

Abstract 210: The Relationship Between Serum Free Fatty Acid Levels After the Return of Spontaneous Circulation and Neurological Outcomes in Out-of-Hospital Cardiac Arrest Patients

Background: Free fatty acids (FFA) are a known risk factor in the development of sudden cardiac death. However, the relationship between FFA and the outcome of out-of-hospital cardiac arrest (OHCA) patients remains unclear. We aimed to examine the association between FFA and neurological outcomes in OHCA patients. Methods: This prospective observational study included adult (≥ 18 years) OHCA patients between February 2016 and December 2022. We measured serial FFA levels within 1 h after ROSC and at 6 h, 12 h, 24 h, 48 h, and 72 h after the return of spontaneous circulation (ROSC). The primary outcome was neurological outcome at 6 months. A poor neurological outcome was defined by cerebral performance categories 3, 4, and 5. Results: A total of 147 patients were included. Of them, 104 (70.7%) had poor neurological outcomes, whereby the median FFA levels within 1 h after ROSC (0.72 vs. 1.01 mol/L), at 6 h (1.19 vs. 1.90 mol/L), 12 h (1.20 vs. 1.66 mol/L), and 24 h (1.20 vs. 1.95 mol/L) after ROSC were significantly lower than in good outcome group. The FFA levels at 6 h (odds ratio [OR], 0.583; 95% confidence interval [CI], 0.370-0.919; P = 0.020), and 12 h (OR, 0.509; 95% CI, 0.303-0.854; P = 0.011) after ROSC were independently associated with poor neurological outcomes. Conclusions: The lower FFA levels at 6 h and 12 h after ROSC were associated with poor neurological outcomes in patients with OHCA. FFA may reflect oxidative metabolism as well as oxidative stress.

СИНДРОМ БРУГАДА В КЛИНИЧЕСКОЙ ПРАКТИКЕ

Brugada syndrome is a congenital channelopathy with an autosomal dominant type of inheritance and low penetrance, characterized by the presence of a typical clinical and electrocardiographic symptom complex, including a special form of blockade of the right bundle branch block with ST segment elevation in one or more right chest leads on the electrocardiogram, the absence of organic pathology of the heart and various life-threatening ventricular arrhythmias, which can lead to the development of sudden cardiac death. The article defines the concept of "Brugada's syndrome", the geography and frequency of occurrence of the disease. It is indicated that more than 450 pathogenic variants in 24 genes are involved in the development of Brugada syndrome. The article presents two main hypotheses of pathogenesis, describes the electrocardiographic picture, three types of ECG changes, clinical manifestations and classification of the Brugada syndrome. Listed diseases with which it is necessary to carry out differential diagnosis of Brugada syndrome. Various aspects of the treatment of Brugada syndrome are presented: non-drug methods, pharmacotherapy, installation of an implantable automatic cardioverter-defibrillator, epicardial catheter ablation of abnormal areas of the anterior part of the outflow tract of the right ventricle.

Mechanisms of Damage to the Cardiovascular System in COVID-19

The review article is devoted to the analysis of the literature on the various mechanisms of damage to the cardiovascular system in COVID-19. The article briefly outlines the epidemiology and urgency of the COVID-19 problem, describes the features of the clinical picture of heart muscle damage in COVID-19. The pathophysiology, morphology and pathogenetic mechanisms of myocardial involvement in cases of SARS-CoV-2 lesion are considered in detail. The authors present a diagram of various mechanisms of myocardial damage in COVID-19, which includes mediated damage to the heart muscle through angiotensin-converting enzyme 2, myocardial damage caused by hypoxemia, microvascular heart damage, and systemic inflammatory response syndrome. A detailed scheme of cardiomyocyte infection with the involvement of cytokines, which ultimately leads to myocardial remodeling and dilated cardiomyopathy, is presented. The pathophysiological foundations of the development of sudden cardiac death in COVID-19, which include the mechanisms of life-threatening arrhythmias, acute coronary syndrome, and heart failure, are considered. The authors analyzed scientific studies of the toxic effects of COVID-19 drug treatment on the heart muscle, in particular, antiviral, antibacterial, antimalarial agents. Their potential benefits and harms, as well as the likelihood of developing cardiovascular events, in particular sudden cardiac death, were assessed.

Аналіз морфології зубця Т у фазовому просторі на одноканальній електрокардіограмі у дітей із цукровим діабетом 1-го типу

Актуальність. Кардіоваскулярні порушення, що виникають у дітей із цукровим діабетом 1-го типу (ЦД-1), стають основною причиною смертності дорослих пацієнтів і відіграють головну роль у розвитку раптової серцевої смерті. Мета. Вивчення додаткових маркерів дисфункції міокарда у дітей із ЦД-1 шляхом аналізу одноканальної електрокардіографії (ЕКГ) у фазовому просторі. Матеріали та методи. Основну групу становили 83 пацієнти віком 4–16 років із ЦД-1, контрольну групу — 95 школярів віком 12–16 років. За допомогою комплексу «Фазаграф®»(Україна) досліджувалися й автоматично обчислювались параметри ЕКГ першого стандартного відведення. Запис ЕКГ здійснювали у положенні сидячи в стані відносного спокою. Аналіз ЕКГ проводився у часовій і фазовій областях. Результати. У дітей із ЦД-1 на відміну від їх здорових однолітків формується типовий патерн традиційної ЕКГ з високим і широким зубцем Р, подовженим інтервалом QTc, сплощеним та вузьким зубцем Т. Збільшення показника середньоквадратичного відхилення симетрії зубця Т (СКВ βТ) виявлялось у 68,7 % відсотків дітей, хворих на ЦД-1, та лише у 30,5 % практично здорових школярів. Показник СКВ βТ вірогідно зростає зі збільшенням тривалості захворювання на ЦД-1 у дітей. Групу високого ризику з розвитку серцево-судинних ускладнень становлять діти з тривалістю ЦД 3–5 років. Субоптимальний контроль глікемії та контроль високого ризику значно посилюють нестабільність функціонування міокарда від кардіоциклу до кардіоциклу. Висновки. Збільшення показника СКВ βТ може використовуватися як маркер ураження серця у дітей із ЦД-1. Раннє та систематичне обстеження з подальшим аналізом ЕКГ у фазовому просторі та оптимальний контроль глікемії можуть знизити рівень хронічних ускладнень з боку серця у дітей, хворих на ЦД-1.

Temporal trends and sex differences in sudden cardiac death in the Copenhagen City Heart Study

ObjectiveMore knowledge about the development of sudden cardiac death (SCD) in the general population is needed to develop meaningful predictors of SCD. Our aim with this study was to estimate...

Systematic quantification of histologic ventricular fibrosis in isolated mitral valve prolapse and sudden cardiac death

Cardiac fibrosis in mitral valve prolapse (MVP) is implicated in the development of sudden cardiac death (SCD); however, the pattern remains poorly characterized. The purpose of this study was to systematically quantify left and right ventricular fibrosis in individuals with isolated MVP and SCD (iMVP-SCD), whereby other potential causes of death are excluded, compared to a control cohort. Individuals with iMVP-SCD were identified from the Victorian Institute of Forensic Medicine, Australia, and matched for age, sex, and body mass index to control cases with noncardiac death. Cardiac tissue sections were analyzed to determine collagen deposition in the left ventricular free wall (anterior, lateral, and posterior portions), interventricular septum, and right ventricle. Within the iMVP-SCD cases, the endocardial-to-epicardial distribution of fibrosis within the left ventricle was specifically characterized. Seventeen cases with iMVP-SCD were matched 1:1 with 17 controls, yielding 149 samples and 1788 histologic regions. The iMVP-SCD group had increased left ventricular (anterior, lateral, and posterior; all P <.001) and interventricular septum fibrosis (P <.001), but similar amounts of right ventricular fibrosis (P = .62) compared to controls. In iMVP-SCD, left ventricular fibrosis was significantly higher in the lateral and posterior walls compared to the anterior wall and interventricular septum (all P <.001). Within the lateral and posterior walls, iMVP-SCD cases had a significant endocardial-to-epicardial gradient of cardiac fibrosis (P <.01) similar to other known conditions that cause cardiac remodeling. Our study indicates that nonuniform left ventricular remodeling with both localized and generalized left ventricular fibrosis is important in the pathogenesis of SCD in individuals with MVP.

Next generation sequencing in sudden cardiac death (pilot study)

Aim.To search for causal mutations in candidate genes responsible for the development of sudden cardiac death (SCD) in men who died under the age of 45.Materialandmethods.The SCD group (n=37) was formed using the criteria the World Health Organization and the European Society of Cardiology. Autopsy material was collected from men who died suddenly outside medical institutions and underwent forensic medical examination according to the standard protocol. Autopsy revealed no morphological changes that could explain sudden death. The mean age was 32,4±6,4 years. Genomic DNA was isolated from myocardial tissue using phenol-chloroform extraction. Clinical exome sequencing was performed. At first, we analyzed the results of sequencing of 24 genes, mutations in which lead to cardiovascular diseases associated with an increased risk of SCD:KCNQ1,KCNH2,SCN5A,AKAP9,ANK2,CACNA1C,CALM1,CALM2,CAV3,KCNE1,KNCJNE2,KCNE2,SCN4B,SNTA1,MYH2,APOB,KCNA5,TGFB3,NEB,PDX1,FLNC,PLEC,KCND3.Results.Of 37 samples, we revealed 13 probable pathogenic missense mutations in 9 samples (24,3%). Of 13 probable pathogenic variants, 5 were new.Conclusion.This pilot study provides following conclusions: it is necessary to continue molecular autopsy research in Russia; to increase the effectiveness of detecting causal mutations, it is necessary to reduce the age of patients with SCD included in the study; studying the families of deceased; cooperation of experienced specialists — forensic pathologist, laboratory geneticist, cardiologist.

Investigation of genetic factors leading to cardiovascular diseases in persons with risk of sudden cardiac death

About 85% of all sudden death are of cardiological origin. Predisposition to sudden cardiac death is known for the young and adult patients with a hereditary heart disease that can cause sudden cardiac arrest. The purpose of the work was to study the genetic predisposition for cardiovascular diseases in people with a risk of sudden cardiac death. We examined patients aged 19,7±2,1 years with a risk of sudden cardiac death based on specific complaints and medical history, and considering the known markers of the life-threatening arrhythmias. Of the 1000 patients, 167 with a risk of sudden cardiac death were selected according to the questionnaire. In 80 randomly selected patients from this group, gene polymorphisms associated with the development of thrombophilia and hypertension were studied by real time PCR, and in 59 patients the polymorphisms of genes associated with impaired carbohydrate and lipid metabolism were studied. A number of differences were revealed according to the standard 12-channel electrocardiography in comparison with practically healthy individuals. In the study of genetic factors predisposing the development of thrombophilia, hypertension, type 2 diabetes mellitus, lipid metabolism disorders, a high percentage of hetero- and homozygous individuals was revealed by the risk allele of the PAI-1 (83.3%), ITGA2 (69.2%), AGT genes (72.5%), NOS3 (58.8%), PON1 (56%), LEPR (64.3%). The data obtained indicate a significant role of genetic factors in the development of sudden cardiac death, and the synergistic effect of genes, as a result of which the presence of a risk allele in one gene can enhance the expression of another gene.

Heart Rate and Heart Rate Variability of Rhesus Macaques (Macaca mulatta) Affected by Left Ventricular Hypertrophy.

Hypertrophic cardiomyopathy (HCM) is frequently associated with sudden cardiac death, presumably due to the development of malignant arrhythmias. The risk of sudden cardiac death due to HCM has been reported to be predicted by assessing electrocardiographic (ECG) changes including frequencies and complexities of arrhythmias as well as heart rate variability (HRV) as an assessment of autonomic balance. Sudden cardiac death in association with naturally-occurring left ventricular hypertrophy (LVH) has been reported in a colony of rhesus macaques and is under investigation as a potential non-human primate model of human HCM. In the present study, 10 rhesus macaques with LVH and 10 without the signs of LVH confirmed by an echocardiographic examination were recruited for assessing ECG and HRV parameters. ECG morphology on 10-s, 6-lead ECG analysis, and the frequency and complexity of arrhythmias as well as HRV on 20-h ambulatory ECG Holter analyses were assessed. On the standard 10-s 6-lead ECG analysis, P wave and QRS complex duration as well as the QRS complex amplitude were significantly increased in the LVH-affected rhesus macaques compared to control rhesus macaques. Analysis of 20-h Holter monitoring revealed no statistically significant differences in the frequency or the complexity of arrhythmias between the LVH and the control groups. Several HRV parameters were smaller in the LVH group than the control group throughout the majority of Holter recordings showing periods of reduced variability, however, no statistically significant differences were achieved across groups and/or time points. These findings indicate that ECG analysis and Holter monitoring of rhesus macaques are feasible and that ECG morphological changes in association with LVH could be used as a possible component of an antemortem screening tool. The rhesus macaques of this study did not reveal clear indications of risk for sudden cardiac death. Further studies are necessary to determine the etiology of sudden cardiac death due in LVH affected rhesus macaques and identify if any parameters of arrhythmia assessment or HRV can be used to predict the development of sudden cardiac death.

Association of minor heart anomalies with risks of sudden cardiac death

The review focuses on the analysis of study results related to a possible arrhythmogenic effect of minor heart abnormalities and their significance in the stratification of sudden cardiac death risks. Risk stratification of sudden cardiac death is a challenging problem of modern cardiology. Ventricular arrhythmias followed by asystolia are considered to be the main mechanisms of sudden cardiac death development. The incidence of sudden cardiac death is not high in general population but in absolute values it is significantly higher than that in high risk patients. Therefore, additional identification of sudden cardiac death risks in general population and prevention measures seem to be of special interest. Some researchers think that connective-tissue dysplasia followed by the formation of minor heart abnormalities might serve as a potential substrate for arrhythmia development and describe their arrhythmogenic effect. However, the association of minor heart abnormalities with sudden cardiac death risks is not well studied. The literature gives some data on sudden cardiac death incidence in some connective-tissue pathologies, but no variants of minor heart abnormalities leading to sudden cardiac death are described both in domestic and foreign literature. Also, the patients with these pathologies are not included in the sudden cardiac death high risk group.Received 14 November 2017. Revised 4 December 2017. Accepted 19 December 2017.Funding: The study was done with support of Tyumen Cardiology Research Center.Conflict of interest: Authors declare no conflict of interest.Author contributionsConception and study design: V.A. KuznetsovData collection and analysis: A.M. Soldatova, A.V. Fanakov Drafting the article: A.M. SoldatovaCritical revision of the article: V.A. Kuznetsov, A.M. Soldatova Literature review: A.M. Soldatova, A.V. FanakovFinal approval of the version to be published: V.A. Kuznetsov, A.M. Soldatova, A.V. Fanakov

PROBLEMS OF PREVENTION OF SUDDEN CARDIAC DEATH IN ARMED FORCES OF THE RUSSIAN FEDERATION

Currently, in connection with the development of methods for genetic studies, increased attention to the problem of sudden death and its prevention. The majority of stops cardiac activity occur without prior symptoms and is almost always fatal despite resuscitation. At a young age cause of sudden cardiac death often remains unclear even after autopsy, because some diseases, such as channelopathies, or drug-arrhythmia, not associated with any structural changes of the cardiovascular system and result in death in this age group. In recent years, technological progress in the field of genetics has facilitated the study of a large number of genes, which allowed to map several key genes with the reasons for the development of sudden cardiac death, which may allow the stratification of risk in young individuals based on the genetic data (2 figs, bibliography: 38 refs).

Case Report of the Patient with Acute Myocardial Infarction: “From Flatline to Stent Implantation”

SummaryAsystole is a rare primary manifestation in the development of sudden cardiac death (SCD), and survival during cardiac arrest as the consequence of asystole is extremely low. The aim of our paper is to illustrate successful cardiopulmonary resuscitation (CPR) in patients with acute myocardial infarction (AMI) and rare and severe form of cardiac arrest - asystole. A very short time between cardiac arrest in acute myocardial infarction, which was manifested by asystole, and the adequate CPR measures that have been taken are of great importance for the survival of our patient.After successful reanimation, the diagnosis of anterior wall AMI with ST segment elevation was established. The right therapeutic strategy is certainly the early primary percutaneous coronary intervention (PPCI). In less than two hours, after recording the “flatline” and successful reanimation, the patient was in the catheterization laboratory, where a successful PPCI of LAD was performed, after emergency coronary angiography. In the further treatment course of the patient, the majority of risk factors were corrected, except for smoking, which may be the reason for newly discovered lung tumor disease. Early recognition and properly applied treatment of CPR can produce higher rates of survival.

UDDEN CARDIAC DEATH IN CHILDREN AND ADOLESCENTS: PREDICTORS, PROBLEMS OF DIAGNOSIS (literature review)

The review presents information about the most common causes of sudden cardiac death in children and adolescents, predictors of sudden cardiac death in these diseases, modern methods of examination of patients threatened by the development of sudden cardiac death.

GW26-e4504 Sympathetic Nerve Remodeling in Hypertensive Rabbits with Left Ventricular Hypertrophy and Heart Failure

Sympathetic nerve (SN) remodeling plays an important role in the development of sudden cardiac death in patients with myocardial infarction. However, little has been known about the pattern of SN remodeling in patients with hypertensive left ventricular hypertrophy (LVH) or heart failure (HF). We

Left ventricular hypertrophy is associated with the risk of sudden cardiac death

Aims: The echocardiographic identification of risk markers may enhance risk stratification for the development of sudden cardiac death (SCD). However, the value of left ventricular (LV) hypertrophy in the prediction for the risk for SCD is not well known. Methods and results: Echocardiography with the assessment of LV mass was defined in a representative population-based sample of 906 men (age 42-61 years). During an average follow-up period of 20.2 years (interquartile range 18.8-21.3 years), 66 SCDs occurred. The hazard ratio (HR) for SCD was 1.10 (95% confidence interval, CI 1.06-1.15, p<0.001) for each 10 g increment in LV mass, after adjustment for age, alcohol consumption, cigarette smoking, serum low and high density lipoprotein cholesterol, systolic blood pressure, type 2 diabetes, body mass index, high sensitivity C-reactive protein, previous myocardial infarction and cardiorespiratory fitness. Men with elevated LV mass of over 253 grams (highest quartile) had a 3.24-fold (95% CI 1.52 to 6.91, p=0.002) adjusted HR for an SCD as compared to those with LV mass of less than 186 grams (lowest quartile). After additional adjustment for LV function, the relation between LV mass and SCD remained statistically significant in the highest quartile of LV mass (HR 2.72, 95% CI 1.25 to 5.96, p=0.012). The risk for SCD was increased in 175 men with an indexed LV mass of over 125 g/m2 (3.25-fold, 95% CI 1.94 to 5.43, p<0.001). The integrated discrimination index was 0.094 (p=0.0002) indicating the significant level of discrimination improvement with LV mass. Conclusion: LV mass provides an incremental predictive value for SCD beyond that of other well-known risk factors. This study provides evidence that LV hypertrophy improves risk stratification for SCD in the general male population.

Long-term alcohol and caffeine intake and risk of sudden cardiac death in women

Alcohol and caffeine intakes may play a role in the development of sudden cardiac death (SCD) because of their effects on cholesterol, blood pressure, heart rate variability, and inflammation. Our objective was to examine the association between long-term alcohol and caffeine intakes and risk of SCD in women. We examined 93,676 postmenopausal women who participated in the Women's Health Initiative Observational Study. Women were enrolled between 1993 and 1998 and were followed until August 2009. Women completed a food-frequency questionnaire at baseline and again at year 3. We modeled exposure to alcohol 3 ways: by using baseline intake only, a cumulative average of baseline and year 3 intake, and the most recent reported intake (a simple time-varying analysis). Intake of 5-15 g alcohol/d (about one drink) was associated with a nonsignificantly reduced risk of SCD compared with 0.1-5 g/d of baseline intake (HR: 0.64; 95% CI: 0.40, 1.02), of cumulative average intake (HR: 0.69; 95% CI: 0.43, 1.11), and of most recent intake (HR: 0.58; 95% CI: 0.35, 0.96), with adjustment for age, race, income, smoking, body mass index, physical activity, hormone use, and total energy. No association was found between SCD and total caffeine intake (mg/d) or cups of caffeinated coffee, decaffeinated coffee, and caffeinated tea. Our results suggest that about one drink per day (or 5.1-15 g/d) may be associated with a reduced risk of SCD in this population; however, this association was only statistically significant for a model using the most recent alcohol intake. Total caffeine, regular coffee, decaffeinated coffee, and regular tea intake were not associated with the risk of SCD. This trial was registered at clinicaltrials.gov as NCT00000611.

Sudden Cardiac Death in Women

Women are at lower risk for development of sudden cardiac death (SCD) as compared with men. Women with SCD tend to have less structural heart disease and preserved left ventricular systolic function. Coronary artery disease (CAD) is the most common predictor of SCD in women, as it is in men. However, women with SCD are less likely to have underlying CAD than men, suggesting the need to identify risk factors other than CAD or systolic dysfunction for its prediction in women. SCD risk factors in women include heart failure with preserved left ventricular systolic function, abnormal sympathetic uptake as assessed by meta-iodobenzylguanidine uptake, depression, and/or use of antidepressants. This article reviews SCD in women and discusses areas for future research.

Acute Antiarrhythmic Therapy of Ventricular Tachycardia and Ventricular Fibrillation.

Ventricular arrhythmias (ventricular tachycardia and ventricular fibrillation) are often associated with underlying structural heart disease and require prompt assessment and treatment. Acute treatment involves initial hemodynamic stabilization of the patient followed by suppressive treatment with pharmacologic and nonpharmacologic approaches for reducing the risk of recurrence of ventricular arrhythmias and potential development of sudden cardiac death. This article reviews acute antiarrhythmic drug therapy for ventricular arrhythmias based on the clinical presentation.