(Circulation. 1997;95:2694-2699.)
© 1997 American Heart Association, Inc.
Articles |
Treatment of Sudden Cardiac Death
Current Understandings From Randomized Trials and Future Research Directions
From The Clinical Trials Scientific Research Group, Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (M.J.D., E.S.), and the Division of Cardiology, Indiana University School of Medicine (Indianapolis) (D.P.Z.).
Correspondence to Michael J. Domanski, MD, National Heart, Lung, and Blood Institute, Bethesda, MD 20892.
Key Words: death, sudden • cardiovascular disease • arrhythmias
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Introduction |
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Sudden cardiac death (SCD) occurs in
300 000 individuals each year in the United
States.1 This represents about half of the deaths
caused by cardiovascular disease,2 which
in turn represents almost half of all deaths in the United
State annually. Because of this, SCD is recognized as an important
public health problem, and substantial research has been directed at
its prevention. This research has been directed at primary and
secondary prevention of diseases that cause fatal arrhythmias
as well as at treatment of the arrhythmias. Central to this research have been a number of randomized trials in patients known to be at risk for SCD. Taken together, the studies that have been reported and those that will be reported in the near future will paint a coherent picture of the role of the currently available modalities for SCD prevention. It is timely to review the available data and define future research directions.
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Pharmacological Treatment |
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ß-Blockers
Historically, the ß-blockers were the first family of drugs shown to help prevent SCD. Their ability to reduce ventricular arrhythmias3 4 led to studies in the early 1980s of their usefulness in the prevention of SCD in survivors of myocardial infarction.
Among the important studies demonstrating the usefulness of
ß-blockers in the prevention of SCD is the Beta-Blocker Heart Attack
Trial (BHAT), which was a randomized, double-blind, placebo-controlled
study that tested whether the administration of propranolol
in patients with a history of at least one myocardial infarction could
reduce subsequent mortality.5 A total of 3837 patients
were randomized to
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