Survivors of sudden cardiac death: a rational approach to evaluation and therapy of patients surviving ventricular fibrillation.

Abstract

Survivors of out-of-hospital cardiac arrest that is not associated with acute myocardial infarction are at high risk for subsequent life-threatening ventricular tachyarrhythmias. A rational approach to evaluating the underlying disease processes and to formulating a specific treatment plan for these patients is presented. A protocol is suggested whereby existing cardiac conditions are appropriately treated and hemodynamic parameters are optimized. Myocardial ischemia is minimized with drugs or revascularization; this may suffice to prevent recurrence of sudden cardiac death in a small group of patients. For remaining patients at high risk of recurrence, the implantable cardioverter-defibrillator is the therapy associated with the lowest rate of mortality.