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Program in Cardiac Arrhythmias: Sudden Cardiac Death

What is sudden cardiac death?

On July 13, 2008, journalist Tim Russert was recording voiceovers for a newscast, when, suddenly, he collapsed and died. Years before, Russert had been diagnosed with heart disease, and, though he had a weight problem that worsened his condition, he appeared to be doing well overall.
 
A dynamic man and respected commentator, Russert—at only 58 years old—seemed to be in the prime of his life. He relished covering big stories like the 2008 presidential campaign, and he had just celebrated his son’s college graduation with a family trip to Italy. 
 
Russert seemed to take his health seriously. He exercised each morning, took medication to manage his blood pressure, and had recently performed well on a “stress test” that measured blood flow in the arteries in his heart. All told, his heart disease seemed under control. That he could go to work one morning feeling fine — and then die suddenly without any significant warning — is an idea that seems incomprehensible.
 
Tim Russert experienced sudden cardiac death—a condition in which the heart stops beating abruptly and without warning.
 
How many people die of sudden cardiac death?
 
There are different estimates of the number of sudden cardiac deaths in the United States that range from approximately 200,000 to 400,000 persons per year. This is the single largest cause of death related to the heart.
 
What are the current treatments?
       
While there are several causes of sudden cardiac death, one of the most common causes is a rapid, disordered heart rhythm or arrhythmia. These rapid heart rhythms can be restored to normal by shocking the heart either with an Automatic External Defibrillator (AEDs are found in public places such as the airport) or an implantable defibrillator.
 
What are the current challenges in treating sudden cardiac death?
 
While AEDs are highly effective when deployed immediately, unfortunately the vast majority of people who experience sudden cardiac death do not survive. Even more unfortunate, our ability to identify patients who will experience sudden cardiac death prior to the event is poor. This is a critical endeavor to enable treatment to be in place before a person experiences a fatal arrhythmia.
 
How is the Center for Cardiovascular Innovation addressing this problem?
 
Members of the Center have provided national leadership in addressing the pressing issue of sudden cardiac death. Dr. Goldberger, an established researcher and a thought leader in this area, chaired the American Heart Association’s Scientific Statement Committee on risk stratification for sudden cardiac death.  Dr. Bonow served as co-chair of the National Heart, Lung, and Blood Institute’s report on research priorities in sudden cardiac death, and serves on the Joint Commission’s technical panel on sudden cardiac death prevention.
       
Dr. Goldberger has formed a national think tank that brings together a broad array of stakeholders – clinicians, epidemiologists, health economists, government agencies, and industry – on an ongoing basis for the purpose of developing a more focused approach to this problem. He and his team are developing novel approaches to identify those individuals who are at risk for sudden cardiac death, so that these individuals can receive prompt and appropriate treatments to reduce the risk of this devastating condition.



Selected Bibliography

  1. Kong T, Goldberger J, Parker M, Wang T, Kadish A: Circadian variation in human ventricular refractoriness. Circulation 92:1507-1516, 1995.
  2. Levine J, Waller T, Hoch D, Greenberg S, Goldberger J, Kadish A: Implantable cardioverter defibrillator: use in patients with no symptoms and at high risk. Am Heart J 131:59-65, 1996.
  3. Kanaan N, Robinson N, Roth S, Ye D, Goldberger J, Kadish A: Ventricular tachycardia in healing canine myocardial infarction: evidence for multiple reentrant mechanisms. Pacing Clin Electrophysiol 20:245-260, 1997.
  4. Goldberger J, Horvath G, Inbar S, Kadish A: Utility of predischarge and one month transvenous implantable defibrillator tests. Am J Cardiol 79:822-826, 1997.
  5. Taneja T, Goldberger J, Parker N, Johnson D, Robinson N, Horvath G, Kadish A: Reproducibility of ventricular fibrillation characteristics in patients undergoing implantable cardioverter defibrillator implantation. J Cardiovasc Electrophysiol 8:1209-1217, 1997.
  6. Goldberger J, Horvath G, Donovan D, Johnson D, Challapalli R, Kadish A: Detection of ventricular fibrillation by transvenous defibrillating leads: integrated versus dedicated bipolar sensing. J Cardiovasc Electrophysiol 9:677-688, 1998.
  7. Cheema A, Sheu K, Parker M, Kadish A, Goldberger J: Nonsustained ventricular tachycardia in the setting of acute myocardial infarction: tachycardia characteristics and their prognostic implications. Circulation 98:2030-2036, 1998.
  8. Horvath G, Racker DK, Goldberger JJ, Johnson D, Jain S, Kadish A: Electrophysiologic and anatomic heterogeneity in evolving canine myocardial infarction. Pacing Clin Electrophysiol 23(7):1068-1079, 2000.
  9. Taneja T, Goldberger J, Johnson D, Kadish A: Is all ventricular fibrillation the same? Influence of mode of induction on characteristics of ventricular fibrillation. J Cardiovasc Electrophysiol 11:1355-1363, 2000.
  10. Taneja T, Horvath G, Racker DK, Goldberger J, Kadish A: Excitable gap in canine fibrillating ventricular myocardium: Effect of subacute and chronic myocardial infarction. J Cardiovasc Electrophysiol 12:708-715, 2001.
  11. Rankovic V, Karha J, Passman R, Kadish A, Goldberger J: Predictors of appropriate implantable cardioverter-defibrillator therapy in patients with idiopathic dilated cardiomyopathy. Am J Cardiol 89:1072-1076, 2002.
  12. Kadish A, Dyer A, Daubert JP, Quigg R, Estes M, Anderson KP, Calkins H, Hoch D, Goldberger J, Shalaby A, Sanders WE, Schaechter A, and Levine JH, for the Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) Investigators: Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med 350:2151-2158, 2004.
  13. Bello D, Fieno DS, Kim RJ, Pereles FS, Passman R, Song G, Kadish AH, Goldberger JJ: Infarct morphology identifies patients with substrate for sustained ventricular tachycardia. J Am Coll Cardiol 45(7):1104-1108, 2005.
  14. Kadish A, Schaechter A, Subacius H, Thattassery E, Sanders W, Anderson KP, Dyer A, Goldberger J, Levine J: Patients with recently diagnosed nonischemic cardiomyopathy benefit from implantable cardioverter-defibrillators. J Am Coll Cardiol 47:2477-2482, 2006.
  15. Goldberger J, Subacius H, Schaechter A, Howard A, Berger R, Shalaby A, Levine J, Kadish A, for the Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) Investigators: Effects of statin therapy on arrhythmic events and survival in patients with nonischemic dilated cardiomyopathy. J Am Coll Cardiol 48:1228-1233, 2006.
  16. Robin J, Weinberg K, Tiongson J, Carnethon M, Reddy M, Ciaccio C, Quadrini M, Hsu J, Fan J, Choi P, Kadish A, Goldberger J, Passman R: Renal dialysis as a risk factor for appropriate therapies and mortality in implantable cardioverter-defibrillator recipients. Heart Rhythm 3(10):1196-1201, 2006.
  17. Dasgupta A, Montalvo J, Medendorp S, Lloyd-Jones DM, Ghossein C, Goldberger J, Passman R: Increased complication rates of cardiac rhythm management devices in ESRD patients. Am J Kidney Dis 49:656-63, 2007.
  18. Sanders GD, Al-Khatib SM, Berliner E, Bigger JT, Buxton AE, Califf RM, Carlson M, Curtis AB, Curtis JP, Domanski M, Fain E, Gersh BJ, Gold MR, Goldberger J, Haghighi-Mood A, Hammill SC, Harder J, Healey J, Hlatky MA, Hohnloser SH, Lee K, Mark DB, Mitchell B, Phurrough S, Prystowsky E, Smith JM, Stockbridge N, Temple R: Preventing tomorrow’s sudden cardiac death today: part II: translating sudden cardiac death risk assessment strategies into practice and policy. Am Heart J 153:951-959, 2007.
  19. Goldberger JJ, Cain ME, Hohnloser SH, Kadish AH, Knight BP, Lauer MS, Maron BJ, Page RL, Passman RS, Siscovick D, Stevenson WG, Zipes DP: American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific statement on noninvasive risk stratification techniques for identifying patients at risk for sudden cardiac death. A scientific statement from the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention. Circulation 118(14):1497-1518; 2008.
  20. Goldberger JJ: Evidence-based analysis of risk factors for sudden cardiac death. Heart Rhythm 6:S2-7, 2009.
  21. Goldberger JJ, Passman R: Implantable cardioverter defibrillator therapy after acute myocardial infarction: The results are not shocking. J Am Coll Cardiol 54(22):2001-5, 2009.
  22. Kadish AH, Bello D, Finn JP, Bonow RO, Schaechter A, Subacius H, Albert C, Daubert JP, Fonseca CG, Goldberger JJ: Rationale and design for the Defibrillators to Reduce Risk by Magnetic Resonance Imaging Evaluation (DETERMINE) Trial. J Cardiovasc Electrophysiol 20(9):982-987, 2009.
  23. Gordon D, Kadish AH, Koolish D, Taneja T, Ulphani J, Goldberger JJ, Ng J: High resolution electrical mapping of depolarization and repolarization alternans in an ischemic dog model. Am J Physiol 298(2):H352-359, 2010.
  24. Goldberger JJ: The Coin Toss: Implications for risk stratification for sudden cardiac death. Am Heart J 160(1):3-7, 2010.
  25. Patel RB, Ng J, Reddy V, Chokshi M, Parikh K, Subacius H, Alsheikh-Ali AA, Nguyen T, Link MS, Goldberger JJ, Ilkhanoff L, Kadish AH: Early repolarization associated with ventricular arrhythmias in patients with chronic coronary artery disease. Circulation Arrhythmia and Electrophysiology 3: 489-495, 2010.
  26. Fishman GI, Chugh S, DiMarco J, Albert C, Anderson M, Bonow RO, Buxton A, Chen PS, Estes M, Jouven X, Kwong R, Lathrop D, Mascette A, Nerbonne J, O’Rourke B, Page R, Roden D, Rosenbaum DS, Sotoodehnia N, Trayanova N, Zheng ZJ. Sudden cardiac death prediction and prevention: report from a National Heart, Lung, and Blood Institute and Heart Rhythm Society workshop. Circulation 2010;122:2335-2348
  27. Bello D, Einhorn A, Kaushal R, Kenchaiah S, Raney A, Fieno D, Narula J, Goldberger J, Shivkumar K, Subacius H, Kadish A: Cardiac magnetic resonance imaging: infarct size is an independent predictor of mortality in patients with coronary artery disease. Magn Reson Imaging.29:50-56, 2011.
  28. Goldberger JJ, Buxton AE, Cain M, Costantini O, Exner DV, Lloyd-Jones D, Kadish AH, Knight BP, Lee B, Moss A, Myerburg R, Olgin J, Passman R, Rosenbaum D, Stevenson W, Zareba W, Zipes DP: Risk stratification for sudden cardiac death: Identifying the roadblocks. Circulation 123(21):2423-2430, 2011.

 

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