Special Report, Sudden Cardiac Death Prediction and Prevention

Despite the significant decline in coronary artery disease (CAD) mortality in the second half of the 20th century, SCD continues to claim 250,000 to 300,000 US lives annually. In North America and Europe the annual incidence of SCD ranges between 50 to 100 per 100,000 in the general population. Because of the absence of emergency medical response systems in most world regions, worldwide estimates are currently not available.

The Heart Rhythm Society and the NHLBI partnered to hold workshop to discover emerging approaches for improved prediction and prevention of sudden cardiac death (SCD). The workshop was held on September 29-30, 2009, in Washington, D.C. The panel, consisting of two dozen arrhythmia investigators, was asked to consider the three broad areas of basic, clinical and population sciences.

After deliberation on available information as well as critical needs for SCD prediction and prevention, the group came to a consensus, identifying investigational gaps and developing research recommendations in six high-priority areas, is outlined in a special report, Sudden Cardiac Death Prediction and Prevention (PDF, 293K) originally published in the November 30, 2010 issue of Circulation.

Recommendations (not prioritized):

1. Establish multi-scale integrative models, utilizing molecular, cellular, organ-level, animal and computational approaches, and apply these models to determine arrhythmia mechanisms.
2. Establish high throughput experimental strategies to rapidly determine the functional relevance of newly discovered genes associated with arrhythmias in humans.
3. Develop novel risk stratification strategies to improve outcomes in select populations:
   • Patients with ICD indications based on current guidelines
   • Other patients at risk, such as:
     • Coronary artery disease with left ventricular ejection fraction (EF) > 35%
     • Early phase post acute myocardial infarction
     • Heart failure with preserved systolic function
     • Left ventricular hypertrophy
4. Facilitate study of well-phenotyped SCD and control populations, including understudied subgroups.
5. • Establish standardized definitions, including of SCD
   • Improve understanding of presenting arrhythmias, i.e., ventricular fibrillation, pulseless electrical activity, asystole
   • Create opportunities for collaborative analysis of shared data
6. Develop and validate a SCD risk score utilizing phenotypic, biologic and non-invasive markers
7. Establish strategies for SCD prevention that can be employed in the general population, targeting intermediate risk phenotypes

The Heart Rhythm Society, in collaboration with NHLBI would establish a consortium of academic centers for the collaboration of research and the advancement of innovations in EP, including the delivery of patient care, patient safety and quality measures.

“With the support of HRS and NHLBI, the workshop provided a unique venue to tackle complex biomedical issues,” said Glenn Fishman, MD, FHRS, at New York University. “It allowed experts the opportunity to challenge old concepts and debate new ideas, with the hope that the individual and collective creativity would provide a useful roadmap for future exploration.”

Background Information:
The National Heart, Lung, and Blood Institute (NHLBI), in partnership with the Heart Rhythm Society, convened a Workshop of experts in cardiac electrophysiology on September 29-30, 2009 at the Washington, D.C. headquarters of the Society. A group of two dozen arrhythmia investigators, with expertise in basic, clinical and population sciences, met to explore emerging approaches for improved prediction and prevention of sudden cardiac death. These approaches include novel non-invasive imaging modalities, strategies that emerge from mining data from existing large clinical studies and ICD cohorts, and those from fundamental science studies of arrhythmia mechanisms. The purpose was to provide recommendations for the NHLBI and the scientific community for future research approaches to improve prediction and prevention of sudden cardiac death. Visit the NHLBI website for a summary of the workshop.