3 years ago

Sudden Death Mechanisms in Non-ischemic Cardiomyopathies; Insights gleaned from clinical implantable cardioverter-defibrillator trials.

Sudden cardiac death (SCD) represents a major cause of death among patients with heart failure. While scar-based, macro-reentrant ventricular tachycardia and ventricular fibrillation (VT/VF) is the primary etiology for SCD among patients with ischemic cardiomyopathy, a more diverse set of mechanisms and substrates are likely at play for the diverse group of patients characterized by non-ischemic, dilated cardiomyopathy (NICM). These causes may include scar-based re-entry, but also neurohormonal stimulation (sympathetic, parasympathetic, renin-angiotensin-aldosterone), inflammation, and non-arrhythmic processes occurring in the context of a genetic predisposition. In addition to basic and translational science, observations from large randomized clinical trials of implantable cardioverter-defibrillators (ICDs) can also offer insight and support for specific mechanisms of SCD in these patients. The present review will discuss the background of SCD in NICM, its potential mechanisms based upon experimental and theoretical models, and the evidence for these mechanisms that can be derived from clinical trials of ICD therapy.

Publisher URL: www.sciencedirect.com/science

DOI: S1547527117311086

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