Sudden cardiac death: epidemiology and prevention

Sudden cardiac death (SCD) is considered to be the most frequent mode of death in adults in industrialized countries, but its incidence varies widely depending on definition and the source and quality of underlying data. It is estimated that about 80% of cases are due to coronary heart disease (CHD). The remaining 20% are attributable to a wide variety of inborn, genetically determined, or acquired diseases including a small group with hitherto undefined background.

Prevention primarily encompasses treatment of cardiovascular risk factors to avoid manifestation of CHD. Furthermore, preventive strategies are targeted to define groups of patients with an increased risk for SCD. A major target group are patients with impaired left ventricular function, especially due to myocardial infarction. These patients and some less clearly defined patient groups with nonischaemic cardiomyopathy and heart failure may profit from insertion of an ICD. With regard to pharmacological prevention, treatment of the underlying condition is the mainstay since no antiarrhythmic medication—with the exception of β-blockers in some situations—has shown to be efficacious.