Class Ⅲ antiarrhythmics: put to the SWORD?

摘要

The prediction and prevention of sudden cardiac death remain among the greatest challenges in cardiology. Evidence from attempted cardiopulmonary resuscitation and from fortuitous ambulatory electrocardiographic monitoring at the time of cardiac arrest indicates that ventricular fibrillation, commonly preceded by rapid ventricular tachycardia, is the commonest mode of sudden death. Although sudden cardiac death may present as the first clinical manifestation of cardiac disease, in many patients there is a past history of angina, myocardial infarction, or cardiac failure. Much effort has been devoted to the identification of markers of risk for sudden cardiac death in patients with known heart disease, particularly after myocardial infarction. Early studies identified the independent contribution of frequent ventricular ectopic activity and depressed left ventricular ejection fraction as predictors of sudden death, while more recent studies have implicated autonomic disturbance as manifest by impaired heart rate variability and depressed baroreflex sensitivity.