Circ: EP experts seek to improve SCD prevention

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The outcome of a recent expert consensus workshop on sudden cardiac death (SCD) identified knowledge gaps and offered six specific research recommendations in high priority areas for SCD prediction and prevention, according to a report published in the Nov. 30 issue of Circulation.

The special report emerged after two dozen arrhythmia investigators were asked to consider the three broad areas of basic, clinical and population sciences. The group was led by Glenn I. Fishman, MD, from New York University School of Medicine in New York City.

After deliberation on available information, as well as critical needs for SCD prediction and prevention, the group came to a consensus. The recommendations are (not prioritized):
  • Establish multi-scale integrative models, utilizing molecular, cellular, organ-level, animal and computational approaches, and apply these models to determine arrhythmia mechanisms;
  • Establish high throughput experimental strategies to rapidly determine the functional relevance of newly discovered genes associated with arrhythmias in humans;
  • Develop novel risk stratification strategies to improve outcomes in select populations, such as patients with ICD indications based on current guidelines and other patients at risk, including those with coronary artery disease and LV ejection fraction greater than 35 percent, early phase post-acute myocardial infarction, heart failure with preserved systolic function and LV hypertrophy;
  • Facilitate study of well-phenotyped SCD and control populations, including understudied subgroups to establish standardized definitions, including of SCD, improve understanding of presenting arrhythmias, and create opportunities for collaborative analysis of shared data;
  • Develop and validate a SCD risk score utilizing phenotypic, biologic and non-invasive markers; and establish strategies for SCD prevention that can be employed in the general population, targeting intermediate risk phenotypes.

The recommendations of the report suggest opportunities to improve the ability to identify individuals at moderate and high risk of SCD and to intervene to diminish such risk.

"This report is critical to helping us identify limitations of current understanding and point the way to the most fruitful research avenues for the future," said Douglas L. Packer, MD, president of the Heart Rhythm Society.