Risk for sudden cardiac death in heart failure: Underlying mechanisms and therapeutic modalities

Philip B. Adamson, Emilio Vanoli, Eduardo Gronda

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Sudden cardiac death remains a major challenge to modern cardiology with multiple potential mechanisms that contribute to lethal arrhythmogenesis. Effective prevention strategies include suppression of lethal arrhythmias by preventing autonomic mediated adverse electrical remodeling using beta-adrenergic blockers, coupled with prevention of angiotensin- and aldosterone-dependent structural remodeling and fibrosis. Neurohormonal blockade significantly reduces the relative risk for sudden death, but must be coupled with lethal arrhythmia termination strategies using implantable cardioverter defibrillators in patients with depressed left ventricular function. This synergy between medical and device therapies is the basis for effective primary prevention strategies in heart failure patients. Heart failure pathophysiology is complex, but the fundamental mechanisms of disease progression and electrical remodeling leading to high risk for sudden death are similar. As a result, therapies targeting reversal of heart failure disease progression many times impact adverse electrical remodeling, thus lowering risk for lethal arrhythmias. This chapter reviews the fundamental autonomic, neural, structural, and hormonal mechanisms involved in sudden death risk for patients with chronic heart failure. Therapeutic strategies for prevention of sudden death using medications and implanted devices are reviewed along with the mention of promising emerging technologies that may impact sudden death rates. It is clear that heart failure disease management requires expertise in medical and device management of the syndrome. Training programs are evolving to meet the need for specially trained individuals who can fully integrate the skill sets required to provide appropriate medication and device expertise.

Original languageEnglish
Title of host publicationPathophysiology and Pharmacotherapy of Cardiovascular Disease
PublisherSpringer International Publishing
Pages129-149
Number of pages21
ISBN (Print)9783319159614, 9783319159607
DOIs
Publication statusPublished - Jan 1 2015

Keywords

  • Autonomic nervous system
  • Death, sudden
  • Electrophysiology
  • Heart failure
  • Implantable cardioverter defibrillator
  • Renin-angiotensin-aldosterone system

ASJC Scopus subject areas

  • Medicine(all)
  • Pharmacology, Toxicology and Pharmaceutics(all)

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