Prevention of Sudden Cardiac Death
Being diagnosed with a disease that can cause sudden cardiac death is NOT a death sentence. If an individual is predisposed to SCD, then it is actually good to have a diagnosis so that appropriate therapy can be initiated. Unfortunately, many people do not know they are at increased risk for SCD and thus do not have the treatments in place that can prolong their lives indefinitely. The information below lists some of the common measures used to prevent SCD. It is by no means complete, and anyone who is at risk for SCD, should see a physician for optimal care of their particular risk factor.Implantable cardioverter-defibrillator (ICD) +
For people who are at increased risk of succumbing to sudden cardiac arrest, an implantable cardioverter-defibrillator (ICD) device is a godsend. The ICD was invented by Dr. Michel Mirowski in the 1970s at Sinai Hospital of Baltimore, an affiliate of Johns Hopkins. This is a metal device, half the size of a cell phone, which is placed in the chest. It attaches to the heart through several electrode wires. If the heart has an abnormal rhythm or stops, the ICD shocks the heart to reset the heart to a normal rhythm. The ICD has saved thousands of people's lives. Two problems with ICDs exist. One is finding the people who would benefit the most from ICDs - as these are both expensive and not without risks. The second problem is inappropriate shocks- when the ICD "fires" without appropriate cause- and fear of such shocks can lead to anxiety in patients, affecting quality of life. ICD devices are frequently placed in individuals with ARVC/D and in individuals who have had a heart attack.
A second way to prevent sudden cardiac death is the use of an automated external defibrillator (AED). AEDs are often found in public places and places of business such as sports arenas, airports, and grocery stores. These are extremely useful for individuals who have a sudden cardiac arrest, but who are not treated for the condition. If a person was to have a sudden cardiac arrest, a quick-acting good-samaritan could use one of these devices to rapidly restore a heartbeat. AEDs are designed to be used by lay people and have been credited with saving thousands of lives.
In some cases of sudden cardiac arrest, complete heart stoppage is preceded by a dangerous arrhythmia, or abnormal beating of the heart. Sometimes cardiologists can identify an abnormal electrical pathway in the heart and can burn the heart tissue in that area by radiofrequency catheter ablation (RFA). This prevents the abnormal electrical pathway from causing arrhythmias and reduces the risk of sudden cardiac death. This treatment involves the insertion of a catheter through the venous system into the right ventricle. Then the pathway causing arrthymias can be identified by electrical mapping. Finally, this abberant electrical pathway is zapped, reducing the risk of future arrhythmias. This has been used to successsfully treat Wolf-Parkinson-White disease and many other types of arrhythmia.
There are numerous pharmaceutical drugs that have proven benefit against arrhythmias that can lead to sudden cardiac death. In general terms these drugs regulate ion channels or nerve stimulation of the heart. Specifically, they regulate sodium channels, potassium channels, calcium channels, and block sympathetic stimulation of the heart. Different medications work better on different types of arrhythmias. The right medication can only be determined by a physcian based on an individual's unique risk factors.
Some lifestyle modifcations can reduce the likelihood of having a sudden cardiac death event. Unfortunately, some causes of sudden cardiac death occur with greater frequency among individuals who are very physically active. Individuals with hypertrophic cardiomyopathy and ARVC/D, in particular, are told to refrain from intense physical activity which can cause an arrhythmic event to occur. Non-exertional exercise such as walking is encouraged.
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