Risk Stratification for Sudden Cardiac Death in Individuals Without Structural Disease
Implications From Studies of Rare Genetic Arrhythmic Disorders
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
See Article by O’Neal et al
In spite of the advances in modern technology, accurate identification of patients who will experience sudden cardiac death (SCD) remains one of the most significant challenges of cardiology. Although SCD occurs in a higher proportion of adults with traditional cardiac risk factors and a history of heart disease, the absolute number of SCDs which occur in the general population by far outnumber the absolute number of SCDs in the high-risk groups. Thus, the majority of SCD accrues from the general population, in whom there are no currently available screening tools. The overall annual incidence of SCD, based on extrapolation of data from the United States, is ≈1 in 1000 adults over the age of 35 years.1 This low incidence rate requires careful risk assessment and primary prevention tools because the inherent risks of defibrillator use in large number of individuals without structural heart disease who will never experience a fatal arrhythmic event may outweigh the benefit of primary prevention device therapy in this population. Nevertheless, there have been several long-term prospective studies in large cohorts of the general population, evaluating the predictive power of various clinical tools for SCD. These studies have identified multiple factors as associated with the risk of SCD in the general population, including clinical and demographic factors (age, race, hypertension, history of diabetes mellitus, and current smoking), physiological factors (cardiorespiratory fitness), laboratory markers (high sensitivity troponin, CRP, cystin C, and impaired fasting glucose), and ECG parameters (PVCs, …