Dr. Bruce Wilkoff
A four pronged attack preventing sudden arrhythmic death
Panos Vardas from Greece and I chaired this excellent session, while four prominent arrhythmologists provided outstanding strategic insights into how to improve our approach to treating SCD from ventricular arrhythmias. First Silvia Priori, who is now working in New York City at New York University as well as in Pavia, Italy, spoke to us about the progress in genetic screening of our patients. She pointed out that, “Virtually all diseases have a genetic component”. Genetic analysis depends on the influence of Single Nucleotide Polymorphisms (SNP) on the risk of developing a condition like diabetes that also has an impact on the risk of developing SCD. In addition, these SNPs can help determine the response to therapy.
Next, Martin Schalij from Leiden spoke to us about how new imaging and ablation techniques can help reduce the ICD shocks our patients receive. He described how the approach to hemodynamically stable and unstable ventricular tachycardia differs substantially. Particularly for the unstable VT or VF combining the images from CT scans, electroanatomic imaging, MRI and cardiac angiographic with the electrograms during ablation allows us to safely and effectively focus our ablative efforts. He suggested that this may improve the quality of life for our patients and potentially help us to focus ICD implantation on the patients best able to benefit from our efforts.
Helmut Klein who moved from Germany to Rochester, New York then told us how to focus our efforts on improving the quality of our use of ICDs instead of just increasing the number of ICDs implanted. He particularly helped us to see how correct programming of the ICDs can substantially reduce the incidence of shocks, thus improving the quality of life of our patients and possibly improve their mortality benefit.
Finally Stephan Hohnloser from Frankfurt explained how drug therapy can be used for upstream, antiarrhythmic and hybrid therapy. The upstream therapies of Beta blockers, ACE inhibitors, ARBs, Spironolactone, Eplerinone and statins all reduce the risk of SCD by 20% or more in randomized clinical trials. Unfortunately, antiarrhythmic drugs actually increase mortality, except for some promising preliminary data on Dronederone. However, there is no current role of antiarrhythmic drugs to reduce mortality from SCD. However, hybrid therapy of Amiodarone and beta blockers clearly reduced shocks in the OPTIC trial.
This was an excellent session with an emphasis on improving the selection of patients for SCD therapy and improving the quality of life of patients with ICDs. Even though we explored the topic of selecting patients for therapy, we need to make much more progress on reducing the morbidity of ICD therapy due to shocks, both appropriate and inappropriate, as well as the surgical complications to be able to better serve the needs of our patients.
The fight against sudden cardiac death. How to improve what we have?
This congress report accompanies a presentation given at the ESC Congress 2008. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.
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