Survivors of sudden cardiac death: a rational approach to evaluation and therapy of patients surviving ventricular fibrillation
Arthur J. Rabinowitz, MD
James D. Maloney, MDAddress reprint requests to James D. Maloney, MD, Department of Cardiology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland,OH 44195
Survivors of out-of-hospital cardiac arrest that is not associated with acute myocardial infarction are at high risk for subsequent life-threatening ventricular tachyarrhythmias. A rational approach to evaluating the underlying disease processes and to formulating a specific treatment plan for these patients is presented. A protocol is suggested whereby existing cardiac conditions are appropriately treated and hemodynamic parameters are optimized. Myocardial ischemia is minimized with drugs or revascularization; this may suffice to prevent recurrence of sudden cardiac death in a small group of patients. For remaining patients at high risk of recurrence, the implantable cardioverter-defibrillator is the therapy associated with the lowest rate of mortality.