Role of risk stratification and genetics in sudden cardiac death

Can J Physiol Pharmacol. 2017 Mar;95(3):225-238. doi: 10.1139/cjpp-2016-0457. Epub 2016 Oct 16.

Abstract

Sudden cardiac death (SCD) is a major public health issue due to its increasing incidence in the general population and the difficulty in identifying high-risk individuals. Nearly 300 000 - 350 000 patients in the United States and 4-5 million patients in the world die annually from SCD. Coronary artery disease and advanced heart failure are the main etiology for SCD. Ischemia of any cause precipitates lethal arrhythmias, and ventricular tachycardia and ventricular fibrillation are the most common lethal arrhythmias precipitating SCD. Pulseless electrical activity, bradyarrhythmia, and electromechanical dissociation also result in SCD. Most SCDs occur outside of the hospital setting, so it is difficult to estimate the public burden, which results in overestimating the incidence of SCD. The insufficiency and limited predictive value of various indicators and criteria for SCD result in the increasing incidence. As a result, there is a need to develop better risk stratification criteria and find modifiable variables to decrease the incidence. Primary and secondary prevention and treatment of SCD need further research. This critical review is focused on the etiology, risk factors, prognostic factors, and importance of risk stratification of SCD.

Keywords: arrhythmias; arythmies; atrial fibrillation; canalopathies; channelopathies; coronaropathie; coronary artery disease; fibrillation auriculaire; fibrillation ventriculaire; heart failure; insuffisance cardiaque; mort subite cardiaque; prevention; prévention; risk stratification; stratification du risque; sudden cardiac death; ventricular fibrillation.

Publication types

  • Review

MeSH terms

  • Animals
  • Arrhythmias, Cardiac / complications
  • Arrhythmias, Cardiac / genetics*
  • Arrhythmias, Cardiac / mortality
  • Arrhythmias, Cardiac / physiopathology
  • Cardiomyopathies / complications
  • Cardiomyopathies / genetics*
  • Cardiomyopathies / mortality
  • Cardiomyopathies / physiopathology
  • Channelopathies / complications
  • Channelopathies / genetics*
  • Channelopathies / mortality
  • Channelopathies / physiopathology
  • Death, Sudden, Cardiac / etiology*
  • Genetic Markers
  • Genetic Predisposition to Disease
  • Humans
  • Mutation*
  • Phenotype
  • Polymorphism, Genetic*
  • Risk Assessment
  • Risk Factors

Substances

  • Genetic Markers