Risk Stratification and Sudden Cardiac Death
Is It Time to Include Autonomic Variables?
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
- autonomic nervous system
- death, sudden, cardiac
- defibrillators, implantable
- sympathetic nervous system
- ventricular fibrillation
Sudden cardiac death (SCD) remains a major cause of mortality in patients with ischemic cardiomyopathy, and accurate risk stratification strategies can have significant public health implications by reducing mortality and healthcare costs.1 Although effective, the population impact of implantable cardioverter-defibrillators (ICD) on cardiac mortality has been modest,2 in part because of suboptimal risk stratification algorithms and in part because of competing causes of death in this population. In this regard, a validated risk stratification algorithm that can accurately discriminate between those patients at high risk of arrhythmic death and those more likely to die from nonarrhythmic causes is invaluable. Identification of these risk-model variables inevitably requires a thorough understanding of arrhythmogenic causes of death in high-risk populations.
See Article by Fallavollita et al
Cardiac autonomic dysfunction is known to accompany cardiovascular disease. Specifically, myocardial infarction leads to axonal injury and sympathetic denervation, not only in the scar and border-zone regions but also in areas distal to the infarct (viable but denervated myocardium).3 Given that the majority of postganglionic cardiac neurons for sympathetic fibers lie in the stellate and middle cervical ganglia,4–6 in the setting of peripheral nerve damage and in the presence of signals such as neural growth factor, attempts at reinnervation ensue. However, this reinnervation is incomplete and heterogeneous, and a pattern of hyperinnervation is observed in localized border-zone regions,7 along with incomplete innervation and denervation …