Sudden cardiac death is the mode of demise in 30% to 50% of patients with chronic heart failure with reduced ejection fraction.1 Traditionally, physicians have assumed that the abrupt collapse of the circulation is invariably caused by sustained ventricular tachycardia or fibrillation. These arrhythmias may occur without an identifiable trigger or be precipitated by a circadian catecholamine surge, electrolyte imbalances, or the use of drugs with proarrhythmic effects. Regardless of the cause, sustained ventricular tachyarrhythmias are highly responsive to treatment with an implantable cardioverter-defibrillator (ICD). Implantable cardioverter-defibrillators are recommended for patients with heart failure who demonstrate persistent systolic dysfunction after treatment with neurohormonal antagonists and in whom nonsudden deaths are not an important competing short-term risk for demise.2
Packer M. Nonarrhythmic Sudden Cardiac Death in Chronic Heart Failure—A Preventable Event? JAMA Cardiol. Published online July 17, 20194(8):721–722. doi:10.1001/jamacardio.2019.2228
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