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(Circulation. 2007;115:2451-2457.)
© 2007 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Mechanisms of Sudden Cardiac Death in Myocardial Infarction Survivors

Insights From the Randomized Trials of Implantable Cardioverter-Defibrillators

T. Jared Bunch, MD; Stefan H. Hohnloser, MD; Bernard J. Gersh, MB, ChB, DPhil, FRCP

From the Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, Rochester, Minn (T.J.B., B.J.G.), and J.W. Goethe University, Frankfurt, Germany (S.H.H.).

Correspondence to Bernard J. Gersh, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail Gersh.bernard@mayo.edu

Key Words: arrhythmia • death, sudden • defibrillation • ischemia • myocardial infarction • revascularization • tachyarrhythmias

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Sudden death is a catastrophic but unpredictable complication of coronary artery disease and is frequently the consequence of an acute ischemic event.^1–3 The efficacy of the implantable cardioverter-defibrillator (ICD) in reducing sudden cardiac death incidence is irrefutable and strongly supported by evidence from randomized trials of both primary and secondary prevention (Figure 1).^4–8 Nonetheless, the 2 neutral trials^9,10 raise intriguing and puzzling issues in regard to the temporal relationship between myocardial infarction (MI), coronary revascularization, residual myocardial ischemia, and severe left ventricular dysfunction and its impact on the mechanisms of presumed sudden cardiac death and the efficacy of the ICD. In this respect, this commentary addresses current knowledge regarding the mechanisms of death early and late after MI, limitations in our abilities to stratify risk, and analyses from the randomized trials in an attempt to reconcile the apparently paradoxical observation that the highest rate of sudden cardiac death occurs the first few weeks after MI and that the only ICD trial to address this population was neutral.¹⁰

View larger version (28K):   Figure 1. The efficacy of ICD for the primary prevention of death. Data were derived from the study by Solomon et al26 and from the randomized ICD trials for both primary and secondary prevention of sudden cardiac death.4–8

	Mechanisms of Death After MI

 
The causes of death after MI are multifactorial and depend in part on the duration of time that has elapsed since the initial MI. During the acute phase of the MI, sudden death is typically the result of ischemia that provokes lethal ventricular . . . [Full Text of this Article]

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