Sudden Cardiac Death Thirty Years Ago and at Present. The Role of Autonomic Disturbances in Acute Myocardial Infarction Revisited

摘要

The most common cause of sudden cardiac death is ventricularfibrillation (VF). In addition to the status, size and location of theventricular focus, a major pathogenic mechanism triggering VF isautonomic dysbalance (disturbance). This term refers to a widerange of reflex changes in the ratio of sympathetic to vagalventricular activation over time, occurring immediately aftercoronary artery occlusion at the onset of acute myocardialinfarction (AMI). Another trigger of VF is autonomic disturbancedue to emotional stress. Experimental and clinical research intoautonomic disturbances associated with coronary artery occlusionand emotional stress was given considerable attention as early assome 30 years ago when researchers were already searching forways of inhibiting autonomic disturbances using predominantsympathetic and vagal activation by beta-blockers (BB) andatropine, respectively. The aim of our paper is to compare resultsobtained 30 years ago with current status of experimental andclinical research into SCD prevention. Another aim is to identifyquestions that have remained unanswered to date; answers tothese outstanding questions could help further reduce the risk of SCD.