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Over the last ten years, it has become increasingly obvious that sudden death represents the major challenge confronting cardiology in the last part of the XXth Century. Careful epidemiologic studies have established the magnitude of this overall important problem of public health. The frequent association of sudden death with coronary artery disease has been demonstrated. Some of the electrophysiologic mechanisms underlying lethal arrhythmias have been unveiled. In addition, clinical markers permitting identifica tion of high risk individuals have emerged. Finally, different studies have raised some hope as to the ability of therapeutic interventions to protect these patients against a premature and possibly evitable demise. Over the years, a sizable amount of new and relevant information, both basic and clinical, has become available. We felt therefore that a conference on sudden death might be timely. It was decided to organize a small gathering during which experts from different disciplines in cardiology could sit together in a quiet retreat to share their knowledge and discuss issues pertaining to research and therapy that might be of benefit to patients. The conference was held in Liege, on May 7, 8 and 9, 1979. This three day meeting in which re presentatives from seven different countries participated was extremely stimulating. The discussions were very lively and sometimes reflected the divergence of opinion which may persist on some topics.
Sommario
Section 1. Epidemiology and pathology of sudden death.- 1.1. Sudden death: a worldwide problem.- 1.2. Sudden death due to arteriosclerotic heart disease: a study of women.- 1.3. A pathologist's view of sudden cardiac death.- 1.4. Neural pathology of the heart in sudden death.- Section 2. The electrophysiology of lethal arrhythmias.- 2A) Animal myocardial infarction models.- 2.1. Studies on ventricular arrhythmias in animal models of ischemic heart disease: what can we learn?.- 2.2. Ventricular arrhythmias in the first 15 minutes of acute regional myocardial ischemia in the isolated pig heart: possible role of injury currents.- 2.3. Electrophysiological, biochemical and pharmacological aspects of reentrant ventricular arrhythmias in the late myocardial infarction period.- 2B) The nervous system and cardiac arrhythmias.- 2.4. Neural factors and ventricular electrical instability.- 2.5. Autonomic nervous system and sudden death.- 2C) Electrophysiologic mechanisms involved in ventricular tachycardia-fibrillation.- 2.6. Epicardial activation sequences during the onset of ventricular tachycardia and ventricular fibrillation.- 2.7. Electrophysiological observations on ventricular fibrillation in the human heart.- 2.8. Unusual forms of severe ventricular tachyarrhythmias: their relationships with the QT interval and the vago-sympathetic balance.- Section 3. The indicators of high risk for sudden death.- 3A) Clinical profile of high risk individuals.- 3.1. Prehospital cardiac arrest: early and long-term clinical and electrophysiologic characteristics.- 3.2. CCU findings useful for identification of sudden death candidates in the post-hospital phase of myocardial infarction.- 3.3. Factors associated with cardiac death in the posthospital phase of myocardial infarction.- 3B)Methods for detection of high risk patients.- 3.4. Further evaluation of the repetitive ventricular response in man.- 3.5. Detection of patients at high risk for sudden death: the role of electrocardiographic monitoring.- 3.6. Detection of high risk patients for sudden death: the role of myocardial imaging with radioisotopes.- Section 4. Prevention of sudden death.- 4.1. Critical analysis of intervention studies: methodological problems and pitfalls.- 4.2. Prevention of sudden death: the role of beta-blockers.- 4.3. Prevention of sudden death: the role of antiarrhythmic therapy.- 4.4. The possible role of platelets in sudden cardiac death.- 4.5. The automatic implantable defibrillator: a new avenue.- Section 5. Sudden death in noncoronary heart disease.- 5.1. Sudden death in patients with hypertrophic cardiomyopathy.- 5.2. The long QT syndrome.- 5.3. Sudden death in subjects with intraventricular conduction defects.- 5.4. Sudden death in the Wolff-Parkinson-White syndrome.
