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Dr Mary Sheppard



Sudden cardiac Death- book reviewed

Dr Mary Sheppard, Consultant Cardiac Pathologisat at the Royal Brompton Hospital, London, reviews a recently published book on, Sudden cardiac death.

This book*, largely reflects writers from the  Italian and German practise on sudden death. It begins with a definition and introduction to sudden death with its causes which are mainly  ischaemic heart disease and  cardiomyopathy and  the newly introduced channelopathies predominating  in the younger age group. The size of this problem is discussed, showing that cardiovascular death is the main killer in developed countries with sudden death as a common mode of death which has been increasing in recent years. This is explained very well.

The risk of sudden death after myocardial infarction is described particularly in the view of the new era of early reperfusion/stent insertion. Also, sudden death in heart failure and survival after cardiac arrest , which is generally poor. Pathophysiology is very well dealt with,  covering the substrate for arrhythmias, different types of arrhythmias and treatment of these including ablation, drug therapy and implantable defibrillators. An interesting point made is that patients with implantable defibrillators (ICDs) still die because the public erroneously think that implantable defibrillators will avoid the risk of sudden death and make you live forever!. The mode of death in ICD patients is sudden in up to 1/3 of cases and the most common mechanism is ventricular fibrillation treated with an appropriate shock but then followed by electromechanical disassociation. Electrical disassociation probably arises from other fatal events such as large extent ischaemia but it may also be a result of too frequent shocks too closely spaced resulting in severe hemodynamic deterioration.

Primary prevention of sudden death is highlighted with controversy over its widespread application, particularly in ischaemic heart disease patients with poor left ventricular function which is the main risk factor for sudden death in this group of patients. The use of beta blockers, amiodarone, and implantable defibrillators are discussed, with the main trials reported. The role of ICDs in dilated cardiomyopathy and hypertrophic cardiomyopathy is alsocovered. Again, the application is in patients with poor ventricular function in dilated cardiomyopathy and in hypertrophic it is those with a family history, those who have had a previous event, and those with extreme thickening of the ventricle. In the newly described arrhythmogenic right ventricular cardiomyopathy the use of ICD has been demonstrated whereas trials on drugs are not available. In the channelopathies, prevention depends on beta blockers and ICD therapy.

The pharmacological approach is also discussed including use of beta blockers, aldosterone antagonists, ACE inhibitors, angiontensin receptor blocker agents, statins, omega3 fatty acids and magnesium. The issue of sudden death in heart failure is a big issue with application  of implantable defibrillators and the cost of that in the general population. The future of public access to defibrillators,which is also a controversial issue, given the cost of putting public defibrillators in every public  building in the country and training of the public in the use of defibrillators.  in schools and in  sport. There are guidelines in first aid in cardiac arrest and survival after cardiac arrest. Sudden death in children and adolescence with emphasis on cardiomyopathies and channelopathies is highlighted and finally the new inherited arrhythmias with genetic therapy in the future is discussed by international authors who are well established in this area.

Overall this is an excellent book of great use to cardiologists and particularly those who have an interest in sudden death and inherited cardiac disease and  ischaemic heart disease.

I have one major quibble. Pathological input into this book is non-existent and good quality cardiac pathology in the analysis of the causes of sudden cardiac death is essential in any studies of this condition.

  • *Sudden cardiac death
  • Capucci A, Piacenza I,. Informa HealthCare,
  • 2006; ISBN:9781841845784.
  • Price £80.00

Published on: December 10, 2009

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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