Exploring the relationship between sudden cardiac death and arrhythmias: Pathophysiology, risk factors, and implications for prevention and management

https://doi.org/10.53730/ijhs.v2nS1.15300

Authors

  • Abdulrhman Awadh Alharbi KSA, National Guard Health Affairs
  • Samo Nazal Almutairi KSA, National Guard Health Affairs
  • Ahmad Alhelo Alanazi KSA, National Guard Health Affairs
  • Ibrahim Muhammad Al-Arej KSA, National Guard Health Affairs
  • Abdullatif Suliman Alsayegh KSA, National Guard Health Affairs
  • Abdualrhman Ayesh Mohammad Alanazi KSA, National Guard Health Affairs
  • Mohammed Abdullah Alduaybi KSA, National Guard Health Affairs
  • Omar Hussain Alsomali KSA, National Guard Health Affairs
  • Meshal Ibrahim Zaid Al Owias KSA, National Guard Health Affairs
  • Bader Sayah Alanezi KSA, National Guard Health Affairs

Keywords:

Sudden cardiac death, arrhythmias, pathophysiology, risk factors, prevention, management

Abstract

Background: Sudden cardiac death (SCD) is a critical public health issue, often linked to underlying arrhythmias that disrupt normal heart rhythm. Understanding the pathophysiology and risk factors associated with arrhythmias is vital for effective prevention and management strategies. Aim: This study aims to explore the intricate relationship between SCD and arrhythmias, highlighting the pathophysiological mechanisms, identifying significant risk factors, and discussing implications for clinical management and prevention. Methods: A comprehensive literature review was conducted, analyzing studies that examine the causes, diagnosis, and management of SCD related to arrhythmias. Relevant data were extracted from peer-reviewed articles, clinical guidelines, and meta-analyses. The findings were synthesized to elucidate the mechanisms by which arrhythmias contribute to SCD and to identify key risk factors. Results: The findings reveal that a variety of factors contribute to the occurrence of arrhythmias leading to SCD, including structural heart disease, genetic predispositions, and electrolyte imbalances. Ischemic heart disease was identified as the most prevalent cause, with other significant contributors being inherited arrhythmia syndromes and the presence of comorbidities. Additionally, the use of advanced diagnostic tools, such as electrocardiograms and implantable cardioverter-defibrillators, has improved the identification of patients at risk.

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References

Chugh SS, Reinier K, Teodorescu C et al. Epidemiology of sudden cardiac death: clinical and research implications. Prog Cardiovasc Dis. 2008;51:213–28. doi: 10.1016/j.pcad.2008.06.003. DOI: https://doi.org/10.1016/j.pcad.2008.06.003

Adabag AS, Luepker RV, Roger VL, Gersh BJ. Sudden cardiac death: epidemiology and risk factors. Nat Rev Cardiol. 2010;7:216–25. doi: 10.1038/nrcardio.2010.3. DOI: https://doi.org/10.1038/nrcardio.2010.3

Myerburg RJ, Reddy V, Castellanos A. Indications for implantable cardioverter-defibrillators based on evidence and judgment. J Am Coll Cardiol. 2009;54:747–63. doi: 10.1016/j.jacc.2009.03.078. DOI: https://doi.org/10.1016/j.jacc.2009.03.078

Rea TD, Page RL. Community approaches to improve resuscitation after out-of-hospital sudden cardiac arrest. Circulation. 2010;121:1134–40. doi: 10.1161/CIRCULATIONAHA.109.899799. DOI: https://doi.org/10.1161/CIRCULATIONAHA.109.899799

Estes NA. Predicting and preventing sudden cardiac death. Circulation. 2011;124:651–6. doi: 10.1161/CIRCULATIONAHA.110.974170. DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.974170

Niemeijer MN, van den Berg ME, Leening MJG et al. Declining incidence of sudden cardiac death from 1990–2010 in a general middle-aged and elderly population: the Rotterdam study. Heart Rhythm. 2015;12:123–9. doi: 10.1016/j.hrthm.2014.09.054. DOI: https://doi.org/10.1016/j.hrthm.2014.09.054

Bardy GH, Lee KL, Mark DB et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352:225–37. doi: 10.1056/NEJMoa043399.

Echt DS, Liebson PR, Mitchell LB et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial. N Engl J Med. 1991;324:781–8. doi: 10.1056/NEJM199103213241201. DOI: https://doi.org/10.1056/NEJM199103213241201

Nanthakumar K, Epstein AE, Kay GN et al. Prophylactic implantable cardioverter-defibrillator therapy in patients with left ventricular systolic dysfunction: a pooled analysis of 10 primary prevention trials. J Am Coll Cardiol. 2004;44:2166–72. doi: 10.1016/jjacc.2004.08.054. DOI: https://doi.org/10.1016/j.accreview.2005.03.037

Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med. 1997;337:1576–83. doi: 10.1056/NEJM199711273372202. DOI: https://doi.org/10.1056/NEJM199711273372202

Connolly SJ, Gent M, Roberts RS et al. Canadian implantable defibrillator study (CIDS): a randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation. 2000;101:1297–302. doi: 10.1161/01.CIR.101.11.1297. DOI: https://doi.org/10.1161/01.CIR.101.11.1297

Kuck KH, Cappato R, Siebels J, Ruppel R. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest: the cardiac arrest study Hamburg (CASH). Circulation. 2000;102:748–54. doi: 10.1161/01.CIR.102J.748. DOI: https://doi.org/10.1161/01.CIR.102.7.748

Moss AJ, Hall WJ, Cannom DS et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med. 1996;335:1933–40. doi: 10.1056/NEJM199612263352601 DOI: https://doi.org/10.1056/NEJM199612263352601

Buxton AE, Lee KL, Fisher JD et al. A randomized study of the prevention of sudden death in patients with coronary artery disease. N Engl J Med. 1999;341:1882–90. doi: 10.1056/NEJM199912163412503. DOI: https://doi.org/10.1056/NEJM199912163412503

Moss AJ, Zareba W, Hall WJ et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877–83. doi: 10.1056/NEJMoa013474. DOI: https://doi.org/10.1056/NEJMoa013474

Kadish A, Dyer A, Daubert JP et al. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med. 2004;350:2151–8. doi: 10.1056/NEJMoa033088. DOI: https://doi.org/10.1056/NEJMoa033088

Bardy GH, Lee KL, Mark DB et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352:225–37. doi: 10.1056/NEJMoa043399. DOI: https://doi.org/10.1056/NEJMoa043399

Moss AJ, Fadl Y, Zareba W et al. Survival benefit with an implanted defibrillator in relation to mortality risk in chronic coronary heart disease. Am J Cardiol. 2001;88:516–20. doi: 10.1016/S0002-9149(01)01729-5. DOI: https://doi.org/10.1016/S0002-9149(01)01729-5

Køber L, Thune JJ, Nielsen JC et al. Defibrillator implantation in patients with nonischemic systolic heart failure. N Engl J Med. 2016;375:1221–30. doi: 10.1056/NEJMoa1608029. DOI: https://doi.org/10.1056/NEJMoa1608029

Priori SG, Wilde AA, Horie M et al. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes: document endorsed by HRS, EHRA, and APHRS in May 2013 and by ACCF, AHA, PACES, and AEPC in June 2013. Heart Rhythm. 2013;10:1932–63. doi: 10.1016/j.hrthm.2013.05.014. DOI: https://doi.org/10.1016/j.hrthm.2013.05.014

Lyon RM, Cobbe SM, Bradley JM, Grubb NR. Surviving out of hospital cardiac arrest at home: a postcode lottery? Emerg Med Jl. 2004;21:619–24. doi: 10.1136/emj.2003.010363. DOI: https://doi.org/10.1136/emj.2003.010363

Hasselqvist-Ax I, Riva G, Herlitz J et al. Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. N Engl J Med. 2015;372:2307–15. doi: 10.1056/NEJMoa1405796. DOI: https://doi.org/10.1056/NEJMoa1405796

Lund-Kordahl I, Olasveengen TM, Lorem T et al. Improving outcome after out-of-hospital cardiac arrest by strengthening weak links of the local chain of survival; quality of advanced life support and post-resuscitation care. Resuscitation. 2010;81:422–6. doi: 10.1016/j.resuscitation.2009.12.020. DOI: https://doi.org/10.1016/j.resuscitation.2009.12.020

Yannopoulos D, Bartos JA, Raveendran G et al. Coronary artery disease in patients with out-of-hospital refractory ventricular fibrillation cardiac arrest. J Am Coll Cardiol. 2017;70:1109–17. doi: 10.1016/jjacc.2017.06.059. DOI: https://doi.org/10.1016/j.jacc.2017.06.059

Boyce LW, VlietVlieland TP, Bosch J et al. High survival rate of 43% in out-of-hospital cardiac arrest patients in an optimised chain of survival. Neth Heart J. 2014;23:20–5. doi: 10.1007/s12471-014-0617-x. DOI: https://doi.org/10.1007/s12471-014-0617-x

Bækgaard, J. S., Viereck, S., Møller, T. P., Ersbøll, A. K., Lippert, F., & Folke, F. (2017). The effects of public access defibrillation on survival after out-of-hospital cardiac arrest: a systematic review of observational studies. Circulation, 136(10), 954-965. DOI: https://doi.org/10.1161/CIRCULATIONAHA.117.029067

Murakami Y, Iwami T, Kitamura T et al. Outcomes of out-of-hospital cardiac arrest by public location in the public-access defibrillation era. J Am Heart Assoc. 2014;3:e000533. doi: 10.1161/JAHA.113.000533. DOI: https://doi.org/10.1161/JAHA.113.000533

Deakin CD, Shewry E, Gray HH. Public access defibrillation remains out of reach for most victims of out-of-hospital sudden cardiac arrest. Heart. 2014;100:619–23. doi: 10.1136/heartjnl-2013-305030. DOI: https://doi.org/10.1136/heartjnl-2013-305030

Boutilier JJ, Brooks SC, Janmohamed A et al. Optimizing a drone network to deliver automated external defibrillators. Circulation. 2017;135:2454–65. doi: 10.1161/CIRCULATIONAHA.116.026318. DOI: https://doi.org/10.1161/CIRCULATIONAHA.116.026318

Dumas F, Bougouin W, Geri G et al. Emergency percutaneous coronary intervention in post-cardiac arrest patients without ST-segment elevation pattern. JACC Cardiovasc Interv. 2016;9:1011–8. doi: 10.1016/j.jcin.2016.02.001. DOI: https://doi.org/10.1016/j.jcin.2016.02.001

Rodrigues P, Joshi A, Williams H et al. Diagnosis and prognosis in sudden cardiac arrest survivors without coronary artery disease: utility of a clinical approach using cardiac magnetic resonance imaging. Circ Cardiovasc Imaging. 2017;10:e006709. doi: 10.1161/CIRCIMAGING.117.006709. DOI: https://doi.org/10.1161/CIRCIMAGING.117.006709

Herman AR, Cheung C, Gerull B et al. Outcome of apparently unexplained cardiac arrest: results from investigation and follow-up of the prospective cardiac arrest survivors with preserved cardiac arrest survivors with preserved ejection fraction registry. CircArrhythm Electrophysiol. 2016;9:e003619. doi: 10.1161/CIRCEP.115.003619. DOI: https://doi.org/10.1161/CIRCEP.116.003984

Viskin S, Postema PG, Bhuiyan ZA et al. The response of the QT interval to the brief tachycardia provoked by standing: a bedside test for diagnosing long QT syndrome. J Am Coil Cardiol. 2010;55:1955–61. doi: 10.1016/j.jacc.2009.12.015 DOI: https://doi.org/10.1016/j.jacc.2009.12.015

Wong JA, Gula LJ, Klein GJ et al. Utility of treadmill testing in identification and genotype prediction in long-QT syndrome. Circ Arrhythm Electrophysiol. 2010;3:120–5. doi: 10.1161/CIRCEP.109.907865. DOI: https://doi.org/10.1161/CIRCEP.109.907865

Chattha IS, Sy RW, Yee R et al. Utility of the recovery electrocardiogram after exercise: a novel indicator for the diagnosis and genotyping of long QT syndrome? Heart Rhythm. 2010;7:906–11. doi: 10.1016/j.hrthm.2010.03.006 DOI: https://doi.org/10.1016/j.hrthm.2010.03.006

Obeyesekere MN, Klein GJ, Modi S et al. How to perform and interpret provocative testing for the diagnosis of Brugada syndrome, long-QT syndrome, and catecholaminergic polymorphic ventricular tachycardia. Circ Arrhythm Electrophysiol. 2011;4:958–64. doi: 10.1161/CIRCEP.111.965947. DOI: https://doi.org/10.1161/CIRCEP.111.965947

Brugada R, Campuzano O, Sarquella-Brugada P et al. Brugada Syndrome. Methodist Debakey Cardiovasc. 2014;10:25–8. doi: 10.14797/mdcj-10-1-25 DOI: https://doi.org/10.14797/mdcj-10-1-25

Poole JE, Mathisen TL, Kudenchuk PJ et al. Long-term outcome in patients who survive out of hospital ventricular fibrillation and undergo electrophysiologic studies: evaluation by electrophysiologic subgroups. J Am Coll Cardiol. 1990;16:657–65. doi: 10.1016/0735-1097(90)90357-U. DOI: https://doi.org/10.1016/0735-1097(90)90357-U

Krahn AD, Healey JS, Chauhan V et al. Systematic assessment of patients with unexplained cardiac arrest: cardiac arrest survivors with preserved ejection fraction registry (CASPER). Circulation. 2009;120:278–85. doi: 10.1161/CIRCULATIONAHA.109.853143. DOI: https://doi.org/10.1161/CIRCULATIONAHA.109.853143

WaBnig N, Gunther M, Quick S et al. Experience with the wearable cardioverter-defibrillator in patients at high risk for sudden cardiac death. Circulation. 2016;134:635–43. doi: 10.1161/CIRCULATIONAHA.115.019124. DOI: https://doi.org/10.1161/CIRCULATIONAHA.115.019124

Tung R, Boyle NG, Shivkumar K. Catheter ablation of ventricular tachycardia. Circulation. 2011;123:2284–8. doi: 10.1161/CIRCULATIONAHA.110.989079. DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.989079

Chockalingam P, Crotti L, Girardengo G et al. Not all beta-blockers are equal in the management of long QT syndrome types 1 and 2: higher recurrence of events under metoprolol. J Am Coll Cardiol. 2012;60:2092–9. doi: 10.1016/j.jacc.2012.07.046. DOI: https://doi.org/10.1016/j.jacc.2012.07.046

Steinberg C, Padfield GJ, Al-Sabeq B et al. Experience with bisoprolol in long-QT1 and long-QT2 syndrome. J Interv Card Electrophysiol. 2016;47:163–70. doi: 10.1007/s10840-016-0161-2. DOI: https://doi.org/10.1007/s10840-016-0161-2

Schwartz PJ, Priori SG, Locati EH et al. Long QT syndrome patients with mutations of the SCN5A and HERG genes have differential responses to Na+ channel blockade and to increases in heart rate: implications for gene-specific therapy. Circulation. 1995;92:3381–6. doi: 10.1161/01.CIR.92.12.3381. DOI: https://doi.org/10.1161/01.CIR.92.12.3381

Odero A, Bozzani A, De Ferrari GM, Schwartz PJ. Left cardiac sympathetic denervation for the prevention of life-threatening arrhythmias: the surgical supraclavicular approach to cervicothoracic sympathectomy. Heart Rhythm. 2010;7:1161–5. doi: 10.1016/j.hrthm.2010.03.046. DOI: https://doi.org/10.1016/j.hrthm.2010.03.046

Woosley RL, Heise CW, Romero KA. QTdrugs List. Available at: crediblemeds.org

Postema PG, Wolpert C, Amin AS et al. Drugs and Brugada syndrome patients: review of the literature, recommendations and an up-to-date website (www.brugadadrugs.org). Heart Rhythm. 2009;6:1335–41. doi: 10.1016/j.hrthm.2009.07.002. DOI: https://doi.org/10.1016/j.hrthm.2009.07.002

Nademanee K, Veerakul G, Chandanamattha P et al. Prevention of ventricular fibrillation episodes in Brugada syndrome by catheter ablation over the anterior right ventricular outflow tract epicardium. Circulation. 2011;123:1270–9. doi: 10.1161/CIRCULATIONAHA.110.972612. DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.972612

Kaneshiro T, Naruse Y, Nogami A et al. Successful catheter ablation of bidirectional ventricular premature contractions triggering ventricular fibrillation in catecholaminergic polymorphic ventricular tachycardia with RyR2 mutation. Circ Arrhythm Electrophysiol. 2012;5:e14–7. doi: 10.1161/CIRCEP.111.966549. DOI: https://doi.org/10.1161/CIRCEP.111.966549

Visser M, van der Heijden JF, van der Smagt JJ et al. Long-term outcome of patients initially diagnosed with idiopathic ventricular fibrillation: a descriptive study. Circ Arrhythm Electrophysiol. 2016;9:e004258. doi: 10.1161/CIRCEP.116.004258. DOI: https://doi.org/10.1161/CIRCEP.116.004258

Belhassen B, Glick A, Viskin S. Efficacy of quinidine in high-risk patients with Brugada syndrome. Circulation. 2004;110:1731–7. doi: 10.1161/01.CIR.0000143159.30585.90. DOI: https://doi.org/10.1161/01.CIR.0000143159.30585.90

Knecht S, Sacher F, Wright M et al. Long-term follow-up of idiopathic ventricular fibrillation ablation: a multicenter study. J Am Coll Cardiol. 2009;54:522–8. doi: 10.1016/j.jacc.2009.03.065. DOI: https://doi.org/10.1016/j.jacc.2009.03.065

Philips B, Madhavan S, James C et al. Outcomes of catheter ablation of ventricular tachycardia in arrhythmogenic right ventricular dysplasia/cardiomyopathy. Circ Arrhythm Electrophysiol. 2012;5:499–505. doi: 10.1161/CIRCEP.111.968677. DOI: https://doi.org/10.1161/CIRCEP.111.968677

Honarbakhsh S, Srinivasan N, Kirkby C et al. Medium-term outcomes of idiopathic ventricular fibrillation survivors and family screening: a multicentre experience. Europace. 2017;19:1874–80. doi: 10.1093/europace/euw251. DOI: https://doi.org/10.1093/europace/euw251

Quenin P, Kyndt F, Mabo P et al. Clinical yield of familial screening after sudden death in young subjects: the French experience. Circ Arrhythm Electrophysiol. 2017;10:e005236. doi: 10.1161/CIRCEP.117.005236. DOI: https://doi.org/10.1161/CIRCEP.117.005236

Published

15-01-2018

How to Cite

Alharbi, A. A., Almutairi, S. N., Alanazi, A. A., Al-Arej, I. M., Alsayegh, A. S., Alanazi, A. A. M., Alduaybi, M. A., Alsomali, O. H., Al Owias, M. I. Z., & Alanezi, B. S. (2018). Exploring the relationship between sudden cardiac death and arrhythmias: Pathophysiology, risk factors, and implications for prevention and management. International Journal of Health Sciences, 2(S1), 381–395. https://doi.org/10.53730/ijhs.v2nS1.15300

Issue

Vol. 2 No. S1 (2018)

Section

Peer Review Articles
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