Predicting sudden cardiac death in healthy humans: is there more to autonomic balance than we know?

摘要

Sudden cardiac death (SCD) is a major clinical and public health problem that usually results from ventricular fibrillation (VF). In 1998, SCD occurred in -456,000 persons, accounting for more than 60% of cardiac deaths.The majority (-80%) of SCD occurs in patients with underlying acute or chronic ischemic heart disease whereas a small minority (-5%) has no identifiable structural heart disease. Acute myocardial infarction in an otherwise healthy individual results in SCD in -10% of the time and SCD is frequently the first manifestation of heart disease in both men and women. Given the high incidence, unanticipated presentation, and low success of resuscitation, there is considerable interest in identifying individuals at higher risk for SCD when they are still asymptomatic. However, in the general population without known heart disease, other than screening for conventional cardiac risk factors, there is no convincing evidence at this time that routine screening with any test (eg: 12-lead electrocardiography, exercise stress testing, or Holter monitoring) effectively identifies individuals at an increased risk for SCD. The available risk stratifying variables have been limited in their accuracy, applicability, and predictive value.