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Fighting against sudden cardiac death: need for a paradigm shift-Adding near-term prevention and pre-emptive action to long-term prevention

Journal

EUROPEAN HEART JOURNAL
Volume 43, Issue 15, Pages 1457-+

Publisher

OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehab903

Keywords

Sudden cardiac death; Near-term prevention; Implantable cardioverter-defibrillator; Remote monitoring; Symptoms; Artificial intelligence

Funding

  1. Institut National de la Sante et de la Recherche Medicale (INSERM)
  2. French Society of Cardiology

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More than 40 years after the first ICD implantation, sudden cardiac death (SCD) remains a major cause of death worldwide. The current strategy of long-term prevention based on left ventricular ejection fraction has limited impact, as many SCD cases occur in the general population without known risk factors. It has been found that SCD is often preceded by warning symptoms, and prompt medical attention can greatly improve survival. New technologies and digital monitoring allow better identification of individuals at short-term SCD risk, enabling a new approach of near-term prevention based on the hours and minutes preceding SCD.
More than 40 years after the first implantable cardioverter-defibrillator (ICD) implantation, sudden cardiac death (SCD) still accounts for more than five million deaths worldwide every year. Huge efforts in the field notwithstanding, it is now increasingly evident that the current strategy of long-term prevention based on left ventricular ejection fraction as the key selection criterion is actually of very limited impact, also because the largest absolute numbers of SCD are encountered in the general population not known to be at risk. It has been recently reemphasized that SCD is often not so sudden, with almost half of the victims experiencing typical warning symptoms preceding the event. Importantly, heeded and prompt medical attention can dramatically improve survival. Essentially, such timely action increases the chances of the SCD event being witnessed by emergency medical services and provides the opportunity for early intervention. In addition, newer technologies incorporating digital data acquisition, transfer between interconnected devices, and artificial intelligence, should allow dynamic, real-time monitoring of diverse parameters and therefore better identification of subjects at short-term SCD risk. Along with warning symptoms, these developments allow a new approach of near-term prevention based on the hours and minutes preceding SCD. In the present review, we challenge the current paradigm of mid- and long-term prevention using ICD in patients at the highest risk of SCD, and introduce a complementary concept applicable to the entire population that would aim to pre-empt SCD by timely detection and intervention within the minutes or hours prior to the event.

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