Approaches to Sudden Death from Coronary Heart Disease

TLDR

Sudden cardiac death remains a major cause of death from coronary heart disease, largely occurring outside hospitals despite improved inpatient care, and is thought to arise from arrhythmias that may be amenable to drug prophylaxis. The study aims to develop a pre‑event prevention program by identifying high‑risk individuals—particularly those with ventricular premature beats—before initiating drug trials. The authors review epidemiologic and physiologic evidence linking ventricular premature beats to sudden death and propose studies to validate VPB as a risk marker for targeted prevention.

Abstract

Sudden cardiac death (SCD) continues unabated. Coronary care units, while effective in lowering hospital mortality, cannot significantly reduce SCD which occurs primarily outside the hospital and accounts for the majority of deaths from coronary heart disease (CHD). In view of the frequent precipitous nature of SCD, only a program which identifies and protects the victim prior to the event can hope to be successful in preventing the majority of SCD. Since it is likely that SCD is due to an arrhythmia, drug prophylaxis might prove effective. In view of the toxicity of currently available agents, it is mandatory to preselect a population at highest risk before embarking on a drug trial. Ventricular premature beats (VPB) may identify subjects susceptible to SCD. Epidemiologic and physiologic information on VPB is reviewed, and proposals are made for studies designed to establish the usefulness of VPB as a risk factor for SCD.