Sudden Mortality Research Articles

MY APPROACH to obese patients with heart disease

Obesity is a worldwide public health crisis. In the fourth century BC, Hippocrates stated, “Sudden death is more commonly seen in those who are naturally fat than in those who are lean.” According to the Framingham data, the rate of sudden cardiac death (SCD) is 40 times higher in obese men and women. The prevalence of obesity continues to rise and is reaching epidemic proportions in developed countries. The medical care costs of obesity in the United States are staggering. Obesity and its associated cardiometabolic comorbidities such as hypertension, diabetes mellitus, and sleep apnea have been proposed as contributors to the expanding epidemic of coronary artery disease (CAD), heart failure, stroke, and cardiac arrhythmias. CAD and cardiac arrhythmias such as atrial fibrillation (AF) should be viewed as end-organ damage as a result of various cardiac metabolic stresses.

Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death: A Science Advisory From the American Heart Association.

Sudden cardiac death (SCD) accounts for >300 000 deaths in the United States annually.1 Although the majority of these deaths occur in low-risk populations2 in which aggressive interventions are not practical, some higher-risk populations have been established in whom intervention with an implantable cardioverter-defibrillator (ICD) has been shown in randomized trials to reduce mortality.3–7 Additionally, there is a population of patients who may benefit from automatic emergency cardioversion-defibrillation but are not deemed appropriate candidates for ICD implantation at the time of presentation. This group is defined by 2 populations. The first subgroup comprises those who are at perceived risk but for whom there may be optimism for clinical improvement (eg, patients soon after revascularization or those with a recent diagnosis of myocardial infarction [MI] or cardiomyopathy). Alternatively stated, the optimal management of these patients at risk (or perceived risk) during the waiting period before an ICD is indicated remains unknown. The second subgroup includes those who have a clear indication for ICD but also have a contraindication to immediate ICD placement (eg, active infection or unknown prognosis). The wearable cardioverter-defibrillator (WCD) is a device designed for patients at risk of SCD who are not immediate candidates for ICD therapy. By providing automatic therapy, the WCD does not depend on a second person to defibrillate, as required with a manual or automated external defibrillator (AED). Unlike the ICD (including both transvenous and subcutaneous devices), the WCD requires no surgical operation, can be provided for a short period of time, is temporary, and is easily removed. These characteristics of the WCD, along with safety and efficacy data presented to the US Food and Drug Administration (FDA), resulted in approval in the United States in 2002.8 Because of the increasing use of the WCD and uncertainty of indications …

OPTIMAL USE OF BETA-BLOCKERS IN CASE OF CHRONIC HEART FAILURE

Objective – review current data on the use of beta-blockers (BB) in chronic heart failure (CHF). Materials and methods. This article discusses beneficial effects of BB administration in CHF patients. It has been demonstrated that decrease in heart rate underlies clinical efficacy of BB therapy in patients with chronic heart failure. We reviewed the question of the necessity to achieve target doses of BB in the treatment of CHF patients. It has been shown that administration of BB in patients with chronic heart failure and reduced left ventricular ejection fraction increase pumping function of heart, and thus reduce the number of hospitalizations for decompensated heart failure, reducing the risk of total and sudden mortality. We demonstrated substantial advantages of β1-selective BB over nonselective ones with respect to their impact on hemodynamics, metabolic processes, rheological parameters of blood and bronchi. We also considered therapeutic tactics in case of BB administration in CHF patients. Results. Based on the data of the current studies we proved high efficiency and safety of β1-selective BBs in CHF patients. Conclusion. Correct choice of BB in patients with CHF and decrease in heart rate during the treatment can significantly increase an effectiveness of the treatment.

Primary Prevention of Sudden Cardiac Death in Patients with Heart Failure: How Effective is Current Pharmacologic Therapy?

Sudden cardiac death is the most common cause of death in the early stages of heart failure. Implantable cardioverter-defibrillator therapies substantially reduce sudden cardiac death but incur morbidity and are expensive, so are recommended only after failure of optimal medical therapy. Guidelines recommend simultaneous first-line therapy with an angiotensin converting enzyme inhibitor and a beta blocker for heart failure with reduced ejection fraction, with diuretic therapy for symptom relief. The all-cause mortality benefit of angiotensin converting enzyme inhibitors (or angiotensin receptor blockers) in this setting is largely attributable to reduced deaths related to disease progression. Addition of a beta blocker improves both all-cause survival and rates of sudden cardiac death. Where symptoms persist, introduction of a mineralocorticoid receptor antagonist is recommended and can reduce sudden cardiac death. If symptoms continue, substitution of the angiotensin converting enzyme inhibitor with the angiotensin receptor neprilysin inhibitor sacubitril/valsartan significantly reduces all-cause mortality, with the benefit arising from fewer deaths from both sudden cardiac death and worsening heart failure. Further medical interventions should be instituted in specific situations as required. Disappointingly, despite evidence-led guidelines, approximately a quarter of patients who have heart failure with reduced ejection fraction do not receive standard therapy with an angiotensin converting enzyme inhibitor and beta blocker. It remains to be seen if recent guidelines for successive interventions in the event of non-response to standard therapy are more effectively adopted.

Anomalous Aortic Origin of a Coronary Artery Is Not Always a Surgical Disease.

Anomalous aortic origin of the coronary artery (AAOCA) from the opposite sinus of Valsalva with an interarterial course has become a high-profile lesion as a result of its association with sudden cardiac death in otherwise young and healthy individuals. Despite our incomplete knowledge of its pathophysiology and natural history, surgical intervention is often recommended. Evidence now shows AAOCA to be relatively common, with lower than previously suspected rates of sudden cardiac death. Analysis of this information reveals that AAOCA is not always a surgical disease. Future multi-institutional studies will continue to define those subgroups best served by observation or surgery.

Abstract 16387: Preventing Cardiovascular Disease and Sudden Cardiac Death by Pre-screening Athletes

Background: Cardiovascular disease (CVD) and sudden cardiac death (SCD) among young athletes (YA) remains consistent and continues to influence preventative practices and pre-screening debate. In the United States, screening for SCD in young athletes follows the American Heart Association 12-step screening questions focusing on personal history, family history, and physical examination. The European Society of Cardiology (ESC) outlines a pre-participation screening (PPS) method to minimize SCD and cardiac arrest (CA) by using family history, athlete’s history in sports, physical examination, and a resting 12-lead ECG. Negative findings allow athlete to continue with sports, whereas positive findings require athletes to continue with additional diagnostic tests (echo, stress test, etc.) Method: Using the U.S. National Registry of Sudden Death in Athletes from the National Heart, Lung, and Blood Institute Working Group, we analyzed the annual mortality rates of sudden cardiac death in young athletes in the U.S. compared to the sudden cardiac death rates as reported through the Veneto study. Results: In a 1980-2006 study, using the U.S. National Registry of Sudden Death in Athletes, 1866 sudden deaths were evaluated finding 690 cases were correlated to CVD, with a leading cause of hypertrophic cardiomyopathy. Research shows that every 3 days in the U.S., we lose an athlete to SCD. A study from 1979-2004 in the Veneto region in Italy reported an annual SCD incidence of 1.9 deaths/100,000 person-years in screened young athletes and 0.79 deaths/100,000 person-years in unscreened nonathletic participants. Additionally, the study found an 89% decrease in SCD in athletes with 3.6/100,000 person-years from 1979-1980 and a reported 0.4/100,000 person-years in 2003-2004. Conclusion: In the U.S., 690 sudden cardiac deaths out of 1866 sudden deaths (leading cause as hypertrophic cardiomyopathy) may have been detected using the PPS by adding an ECG to the pre-screening examination. It remains significant that the Veneto study demonstrated little change in SCD in unscreened non-athletes throughout 1979-2004 but notes a significant 89% decrease in SCD in screened athletes paralleling with the 1982 implementation of pre-participation screening.

Abstract 17403: Prognositic Significance of T peak - T end Interval in Transthyretin Cardiac Amyloidosis

Introduction: The T peak - T end interval (Tpe) is a measure of transmural dispersion of repolarisation with prolongation of this interval linked to an increased risk of ventricular arrhythmias and sudden death. Patients with cardiac amyloid experience a high rate of sudden cardiac death. Objective: To determine the prognostic utility of the Tpeak-Tend interval in patients with transthyretin (TTR) cardiac amyloidosis. Methods: Of the 240 patients who underwent evaluation for TTR amyloidosis at our tertiary referral center from 1966 to 2010, 39 met inclusion criteria (65 excluded for AF, 66 BBB/Paced Rhythm, 25 CAD, 21 other). Inclusion criteria were presence of histological diagnosis of TTR amyloid and confirmed cardiac involvement by echocardiogram or biopsy and absence of atrial fibrillation (AF) or bundle branch block/paced rhythm on the index surface ECG, or history of coronary heart disease (CAD). Tpe was measured in leads V3 and V5. Cox proportional hazards model were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Kaplan-Meier curves were used to estimate overall survival and differences between curves were estimated using log rank. Primary endpoints were death or heart transplantation. Results: Of the 39 patients, 85% were male, and 69% were mTTR. Mean age 66.4 ± 13.9 years. Mean follow up period of 4.2 ± 3.2 years, 25 died and 5 received heart transplants. Median survival was 3.8 years, with 5 year survival 34%. On univariate analysis, Tpe in lead V3 was predictive of adverse outcome, HR per 10msec, 1.195 (1.051-1.370). Further multivariate analysis, in a model accounting for age, gender, Lead V3 Tpe was independently associated with survival, HR per 10msec, 1.207, (1.094-1.411, p=0.009). Conclusions: The Tpe interval in Lead V3 at diagnosis is a novel, noninvasive independent predictor of survival in transthyretin cardiac amyloidosis patients in sinus rhythm.

Group planarian sudden mortality: Is the threshold around global geomagnetic activity ≥K6?

Sudden deaths in groups of animals have been observed by field and laboratory biologists. We have measured mortalities in large group-housed planarian during the infrequent periods of very intense geomagnetic activity. In 13 separate episodes over the last 5 y we have observed the sudden death in our laboratory of hundreds of planarian if their density was about 1 worm per cc and the global geomagnetic activity was K≥6 the day before or the day of the observation of the mortality. Such mortality never occurred in other conditions or days. Both estimates of the "magnetic moment" of a planarian in magnetic fields above this threshold of sustained magnetic flux density as well as the magnetic energy within the planarian volume predict values that could affect phenomenon associated with the total numbers of pH-dependent charges within each worm. These conditions could affect the Levin-Burr bioelectrical signals and networks that affect patterning information and sustainability in whole living systems. The establishment of a central reservoir for the report of these transient events might allow Life Scientists to more fully appreciate the impact of these pervasive global stimuli upon dense groups of animals.

Sudden adult death syndrome in m.3243A>G-related mitochondrial disease: an unrecognized clinical entity in young, asymptomatic adults.

To provide insight into the mechanism of sudden adult death syndrome (SADS) and to give new clinical guidelines for the cardiac management of patients with the most common mitochondrial DNA mutation, m.3243A>G. These studies were initiated after two young, asymptomatic adults harbouring the m.3243A>G mutation died suddenly and unexpectedly. The m.3243A>G mutation is present in ∼1 in 400 of the population, although the recognized incidence of mitochondrial DNA (mtDNA) disease is ∼1 in 5000. Pathological studies including histochemistry and molecular genetic analyses performed on various post-mortem samples including cardiac tissues (atrium and ventricles) showed marked respiratory chain deficiency and high levels of the m.3243A>G mutation. Systematic review of cause of death in our m.3243A>G patient cohort showed the person-time incidence rate of sudden adult death is 2.4 per 1000 person-years. A further six cases of sudden death among extended family members have been identified from interrogation of family pedigrees. Our findings suggest that SADS is an important cause of death in patients with m.3243A>G and likely to be due to widespread respiratory chain deficiency in cardiac muscle. The involvement of asymptomatic relatives highlights the importance of family tracing in patients with m.3243A>G and the need for specific cardiac arrhythmia surveillance in the management of this common genetic disease. In addition, these findings have prompted the derivation of cardiac guidelines specific to patients with m.3243A>G-related mitochondrial disease. Finally, due to the prevalence of this mtDNA point mutation, we recommend inclusion of testing for m.3243A>G mutations in the genetic autopsy of all unexplained cases of SADS.

Current Indications for Implantable Cardioverter Defibrillators in Non-Ischemic Cardiomyopathies and Channelopathies.

Current indications for implantable cardioverter defibrillators (ICDs) in patients with channelopathies and cardiomyopathies of non-ischemic origin are mainly based on non-randomized evidence. In patients with nonischemic dilated cardiomyopathy (NIDCM), there is a tendency towards a beneficial effect on total mortality of ICD therapy in patients with significant left ventricular (LV) dysfunction. Although an important reduction in sudden cardiac death (SCD) seems to be clearly demonstrated in these patients, a net beneficial effect on total mortality is unclear mostly in cases with good functional status. Risk stratification has been changing over the last two decades in patients with hypertrophic cardiomyopathy (HCM). Its risk profile has been delineated in parallel with the beneficial effect of ICD in high risk patients. Observational results based on "appropriate" ICD interventions do support its usefulness both in primary and secondary SCD prevention in these patients. Novel risk models quantify the rate of sudden cardiac death in these patients on individual basis. Less clear risk stratification is available for cases of arrhythmogenic right ventricular cardiomyopathy (ARVC) and in other uncommon familiar cardiomyopathies. Main features of risk stratification vary among the different channelopathies (long QT syndrome -LQTS-, Brugada syndrome, etc) with great debate on the management of asymptomatic patients. For most familiar cardiomyopathies, ICD therapy is the only accepted strategy in the prevention of SCD. So far, genetic testing has a limited role in risk evaluation and management of the individual patient. This review aims to summarize these criticisms and to refine the current indications of ICD implantation in patients with cardiomyopathies and major channelopathies.

International comparison of sudden unexpected death in infancy rates using a newly proposed set of cause-of-death codes

BackgroundComparing rates of sudden unexpected death in infancy (SUDI) in different countries and over time is difficult, as these deaths are certified differently in different countries, and, even within the...

Pharmacokinetics and Clinical Assessment of Amoxicillin for the Control of Necrotic Enteritis in Broiler-Breeders under Field Conditions

Necrotic enteritis (NE) is an acute Clostridium infection characterised by sudden onset, high mortality and severe necrosis of intestinal mucosa. The present study was conducted to clinically assess the efficacy of amoxicillin to control naturally occurring NE caused by Clostridium perfringens type A in broiler-breeders and to further support the clinical outcome of drug administration with evidence of efficacy based on the pharmacodynamic/ pharmacokinetic correlation. A flock of 34,000 broiler-breeders exhibited an abrupt increase in mortality and a mild decrease in egg production, together with a reduction in body weight (BW). No signs of gross lesions were apparent, except a necrotic pseudomembrane covering the intestinal mucosa. Microbiological cultures from the intestine and PCR revealed the presence of Clostridium perfringens type A. After the administration of an amoxicillin compound (Animox® 500 water soluble powder50%, PHARMAQUA) at the dose of 20 mg kg−1 BW diluted in the drinking water for five consecutive days, the flock recovered normally, the production data reached levels prior to induction of the disease and the intestine tissue was rapidly improved. The minimal inhibitory concentrations (MIC) of the isolated pathogen was determined and a pharmacokinetic study was performed under field conditions. The pharmacodynamic/pharmacokinetic correlation revealed a Cmax/MIC ratio of 167.9, well above the value of 10–12 for a bactericidal and eliminatory effect to be expected. Furthermore, the AUC/MIC ratio was 1383.2, supporting the efficacy of the drug even if used in immunocompromised patients. Based on both clinical and pharmacological evidence amoxicillin can be used for the control of NE during an outbreak.

Effect of quality control circle nursing on self efficacy and prognosis of myocardial infarction recovery patients

Objective To investigate the application nursing effect of quality control circle(QCC)nursing recovery period of myocardial infarction patients. Methods 60 cases of myocardial infarction recovery patients were divided into observation group and control group by QCC nursing as the cut- off point. Patients in control group were given routine nursing, in observation group were given QCC nursing. Health knowledge situation, self- efficacy of facing disease, prognosis and life quality were compared between the two groups. Results Health knowledge of disease knowledge, medication knowledge, reasonable diet, timely review and other aspects in observation group were higher than those of control group, the sense of self- efficacy score was higher than that of control group(P< 0.05). The rate of sudden cardiac death, myocardial infarction, malignant arrhythmia in observation group were lower than those of control group, the improvement of the life quality was higher than that of control group(P<0.05). Conclusions QCC nursing could improve the ability to cope with the disease, the prognosis and life quality of myocardial infarction patients. Key words: Quality control circle care; Myocardial infarction; Recovery; Self efficacy; Prognosis

Automatic SVM classification of sudden cardiac death and pump failure death from autonomic and repolarization ECG markers

BackgroundConsidering the rates of sudden cardiac death (SCD) and pump failure death (PFD) in chronic heart failure (CHF) patients and the cost-effectiveness of their preventing treatments, identification of CHF patients at risk is an important challenge. In this work, we studied the prognostic performance of the combination of an index potentially related to dispersion of repolarization restitution (Δα), an index quantifying T-wave alternans (IAA) and the slope of heart rate turbulence (TS) for classification of SCD and PFD. MethodsHolter ECG recordings of 597 CHF patients with sinus rhythm enrolled in the MUSIC study were analyzed and Δα, IAA and TS were obtained. A strategy was implemented using support vector machines (SVM) to classify patients in three groups: SCD victims, PFD victims and other patients (the latter including survivors and victims of non-cardiac causes). Cross-validation was used to evaluate the performance of the implemented classifier. ResultsΔα and IAA, dichotomized at 0.035 (dimensionless) and 3.73μV, respectively, were the ECG markers most strongly associated with SCD, while TS, dichotomized at 2.5ms/RR, was the index most strongly related to PFD. When separating SCD victims from the rest of patients, the individual marker with best performance was Δα≥0.035, which, for a fixed specificity (Sp) of 90%, showed a sensitivity (Se) value of 10%, while the combination of Δα and IAA increased Se to 18%. For separation of PFD victims from the rest of patients, the best individual marker was TS≤2.5ms/RR, which, for Sp=90%, showed a Se of 26%, this value being lower than Se=34%, produced by the combination of Δα and TS. Furthermore, when performing SVM classification into the three reported groups, the optimal combination of risk markers led to a maximum Sp of 79% (Se=18%) for SCD and Sp of 81% (Se=14%) for PFD. ConclusionsThe results shown in this work suggest that it is possible to efficiently discriminate SCD and PFD in a population of CHF patients using ECG-derived risk markers like Δα, TS and IAA.

Haloperidol and sudden cardiac death in dementia: autopsy findings in psychiatric inpatients.

Treatment with haloperidol has been shown, in studies using death certificates and prescription files, to be associated with an excess of sudden cardiac deaths, and regulatory warnings highlight this risk in patients with dementia. We used autopsy findings to determine whether the rate of sudden cardiac death is greater in cases of unexpected deaths of patients with dementia treated with haloperidol. From 1989 through 2013, 1219 patients with a primary diagnosis of dementia with behavioral disturbance were admitted to a psychiatric hospital, and 65 (5.3%) died suddenly. Sixty-five patients (5.3%) died unexpectedly. Complete post-mortem examinations after the sudden death were performed in 55 (84.6%) patients. Twenty-seven of the autopsied cases (49.1%) had been treated with haloperidol orally (2.2 mg ± 2.1 mg/day), the only antipsychotic used in this cohort. Univariable comparisons and multivariable regression analyses compared the groups of patients with or without sudden cardiac death. The leading causes of death were sudden cardiac death (32.7%), myocardial infarction (25.5% of patients), pneumonia (23.6%), and stroke (10.9%). Patients with sudden cardiac death and those with anatomically established cause of death were similar regarding the use of haloperidol (p = 0.5). Sudden cardiac death patients were more likely to suffer from Alzheimer's dementia (p = 0.027) and to have a past history of heart disease (p = 0.0094), and less likely to have been treated with a mood stabilizer (p = 0.024), but none of these variables were independent predictors of sudden cardiac death. Autopsy data suggest that oral haloperidol is not associated with increased risk of sudden cardiac death in psychiatric inpatients with dementia.

Mortality, sudden death and indication for cardioverter defibrillator implantation in a dialysis population

BackgroundThe incidence of sudden death among dialysis patients is high, but end stage renal disease was an exclusion criterion in the trials that demonstrated the benefit of implantable cardioverter defibrillator (ICD) for sudden death prevention. MethodsDialysis patients alive on January 2010 or starting dialysis between January 2010 and January 2013 were enrolled and retrospectively evaluated. Patients were divided into three groups: No-Indication, Indication–With ICD and Indication–Without ICD. Cox and Fine and Gray regression models were used to estimate the total and cause-specific (sudden or non-sudden) mortality hazard ratio (HR, HRcpRisk), respectively. Survival was defined as the time from start of dialysis to the time of death. Results154/2072 patients (7.4%) had indication for ICD implantation and 52 (33.8%) of them received the device; 688 (33.2%) deaths were recorded. Mortality was different among groups [Indication–With ICD vs No-Indication: HR 1.59 (95% CI 1.06–2.38) and Indication–Without ICD vs No-Indication: HR 2.67 (95% CI 2.09–3.39, p<0.001)]. 84/688 (12.2%) were sudden deaths. The cumulative incidence of sudden death was higher in patients with ICD indication [Indication–With ICD vs No-Indication HRcpRisk 3.21 (95% CI 1.38–7.40) and Indication–Without ICD vs No-Indication: HRcpRisk 4.19 (95% CI 2.38–7.39), p<0.001], but also No-Indication patients showed a high rate of sudden death [8.5% (95% CI.6.5–10.9) at 8years of follow-up]. ConclusionsDialysis patients with ICD indication had a worse survival than No-Indication subjects and the prognosis was particularly poor for the Indication–Without ICD group. Sudden death incidence was much higher than in the general population, even among No-Indication subjects.

Effect of Age on Survival and Causes of Death After Primary Prevention Implantable Cardioverter-Defibrillator Implantation

The benefit of implantable cardioverter-defibrillators (ICDs) remains controversial in elderly patients and may be attenuated by a greater risk of nonarrhythmic death. We examined the effect of age on outcomes after prophylactic ICD implantation. All patients with coronary artery disease or dilated cardiomyopathy implanted with an ICD for primary prevention of sudden cardiac death in 12 French medical centers were included in a retrospective observational study. The 5,534 ICD recipients were divided according to age: 18 to 59 years (n = 2,139), 60 to 74 years (n = 2,693), and ≥75 years (n = 702). Greater prevalences of coronary artery disease and atrial fibrillation at the time of implant were observed with increasing age (both p <0.0001). During a mean follow-up of 3.1 ± 2.0 years, the annual mortality rate increased with age: 3.1% per year for age 18 to 59 years, 5.7% per year for age 60 to 74 years, and 7.5% per year for age ≥75 years (p <0.001). Older age was independently associated with a greater risk of death (adjusted odds ratio 1.43, 95% confidence interval 1.14 to 1.80 for age 60 to 74 years; and adjusted odds ratio 1.65, 95% confidence interval 1.22 to 2.22 for age >75 years). Proportions of cardiac deaths (55.2%, 57.6%, and 57.0%, p = 0.84), including ICD-unresponsive sudden death (9.9%, 6.0%, and 10.6%, p = 0.08), and rates of appropriate ICD therapies were similar in the 3 age groups. Older age was independently associated with a higher rate of early complications and a lower rate of inappropriate therapies. In conclusion, older patients exhibited higher global mortality after ICD implantation for primary prevention, whereas rates of sudden deaths and of appropriate device therapies were similar across age groups.

Risk and Causes of Death in Patients After Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

BackgroundBecause the final myocardial scar might be theoretically associated with an increased risk of sudden cardiac death, the long-term clinical course of patients who undergo alcohol septal ablation (ASA) is still a matter of debate. In this retrospective multicentre study, we report outcomes after ASA, including survival, analysis of causes of deaths, and association between time and cause of death. MethodsWe enrolled 366 consecutive patients (58 ± 12 years, 54% women) who were treated using ASA and followed-up for 5.1 ± 4.5 years. ResultsThe in-hospital and 30-day mortality were 0.5% and 0.8%, respectively; the ASA-related morbidity was < 20%. Overall, 52 patients died during 1867 patient-years, which means the all-cause mortality rate was 2.8% per year. The mortality rates of sudden death and sudden death with an appropriate implantable cardioverter-defibrillator (ICD) discharge were 0.4% and 1% per year, respectively. Patients with sudden death or appropriate ICD discharge experienced these mortality events at younger age than patients who died of other hypertrophic obstructive cardiomyopathy-related causes (60.8 years [range, 52-71.5 years] vs 72.4 years [range, 64.2-75.2 years]; P = 0.048). A total of 292 patients (80%) had an outflow gradient ≤ 30 mm Hg, and 327 patients (89%) were in New York Heart Association class ≤ II at the last clinical check-up. ConclusionsASA had low procedure-related mortality, with subsequent 1% occurrence of sudden mortality events per year and 2.8% mortality rate per year in the long-term follow-up. Patients with sudden death or ICD discharge experienced the mortality events approximately 1 decade earlier than patients who died from other causes not related to hypertrophic cardiomyopathy.

Electrocardiographic profile of adenosine pharmacological stress testing.

Adenosine stress testing in conjunction with radionuclide myocardial perfusion imaging has become a common approach for the detection of coronary artery diseases in patients who are unable to perform adequate levels of exercise. However, specific electrocardiographic alterations during the test have been rarely described. Using a Chinese population, the aim of the present study was to provide a detailed electrocardiographic profile of adenosine stress testing. The study population included 1,168 consecutive outpatients who had undergone adenosine-induced stress myocardial perfusion imaging. Electrocardiographic data during and immediately following the adenosine infusion were collected, and the corresponding myocardial perfusion images were assessed. During adenosine infusion, 174 transient and 47 persistent arrhythmic events occurred in 110 patients (9.42%). Furthermore, frequent premature atrial contractions occurred in 65 individuals and frequent premature ventricular contractions were observed in 73 individuals. Atrioventricular block (AVB) occurred in 75 patients [first degree (I°) AVB, 16; second degree (II°) AVB, 58; third degree AVB, 1), while sinoatrial block occurred in eight patients. ST depression emerged in 69 patients. Patients with a baseline I° AVB had an increased risk of a II° AVB, and patients exhibiting baseline ST depression were more likely to have a further depressed ST segment during the stress test (odds ratio, 28.68 and 5.01, respectively; both P<0.001). Following adenosine infusion, 10 patients (0.86%) exhibited newly occurred arrhythmic events. However, no patient presented with acute myocardial infarction or sudden mortality. In conclusion, the results demonstrated that adenosine infusion was a safe method, despite the relatively high incidence of arrhythmic events. The majority of arrhythmias that occurred during infusion were transient, were reversible with the termination of infusion and did not indicate abnormal perfusion results.

Psychiatric medications and sudden cardiac death: putting the risk in perspective.

A potential adverse effect of some psychiatric medications is an abnormally prolonged corrected QT (QTc) interval and an increased risk of developing Torsade de Pointes (TdP), which is associated with sudden death. Because antidepressant and antipsychotic drug use is increasing and rates of sudden cardiac death are decreasing, the proportion of sudden cardiac death cases that may be attributed to these drugs is likely to be exceedingly small compared to other risk factors. A comprehensive review of the published literature has concluded that there is little evidence that psychotropic drug-associated QTc interval prolongation by itself is sufficient to predict TdP.