The AHA Guidelines and Scientific Statements Handbook

Chapter 17 Ventricular Arrhythmias and Sudden Cardiac Death

GROUP

High risk subgroup

Any prior

coronary event

Ejection fraction <35%

or heart failure

Cardiac arrest survivor

Arrhythmia Risk

markers post MI

General population

Myerburg RJ. Circulation.1998;97:1514-1521.

0 100,000 200,000 300,000

No. of Sudden Deaths

Per Year

(^0510202530)
Incidence of Sudden Death
(% of group)

Incidence Events

MADIT II ANDSCD-HeFT

AVID, CIDS AND CASH

MADIT I AND MUSTT

Fig. 17.1 Absolute numbers of events and event rates of SCD in the general population and in specifi c subpopulations over 1 year. General
population refers to unselected population age greater than or equal to 35 years, and high-risk subgroups to those with multiple risk factors
for a fi rst coronary event. Clinical trials that include specifi c subpopulations of patients are shown in the right side of the fi gure. AVID,
Antiarrhythmics Versus Implantable Defi brillators; CASH, Cardiac Arrest Study Hamburg; CIDS, Canadian Implantable Defi brillator Study;
EF, ejection fraction; HF, heart failure; MADIT, Multicenter Automatic Defi brillator Implantation Trial; MI, myocardial infarction; MUSTT,
Multicenter UnSustained Tachycardia Trial; SCD-HeFT, Sudden Cardiac Death in Heart Failure Trial. Redrawn from Myerburg RJ, Kessler KM,
Castellanos A. SCD. Structure, function, and time-dependence of risk. Circulation. 1992;85:12–10.

sudden death, other than those who present with
arrhythmia usually depends on their suffering other
symptoms related to their underlying pathology or
they may have the good fortune to be identifi ed by
chance when examined or investigated for occupa-
tional, pre-operative, or insurance purposes. By far the
majority of sudden cardiac death incidents occur in
victims who have never presented to a physician with
any relevant illness or chance circumstance that allows
their risk to be detected [9] (Fig. 17.1).

Noninvasive evaluation

Resting electrocardiogram
Recommendations
Class I
Resting 12-lead ECG is indicated in all patients who
are evaluated for ventricular arrhythmias. (Level of
Evidence: A)

Exercise testing

Recommendations

Class I

1 Exercise testing is recommended in adult patients

with ventricular arrhythmias who have an interme-

diate or greater probability of having CHD by age,

gender, and symptoms to provoke ischemic changes

or ventricular arrhythmias. (Level of Evidence: B)

2 Exercise testing, regardless of age, is useful in

patients with known or suspected exercise-induced

ventricular arrhythmias, including catecholaminer-

gic VT, to provoke the arrhythmia, achieve a diag-

nosis, and determine the patient’s response to

tachycardia. (Level of Evidence: B)

Class IIa

Exercise testing can be useful in evaluating response

to medical or ablation therapy in patients with