Внезапная сердечная смерть и ишемическая болезнь сердца

Coronary heart disease in 80% of cases can be the substrate of fatal arrhythmias and sudden cardiac death (SCD). Patients with resuscitated cardiac arrest, myocardial infarction with reduced ejection fraction in the past medical history, the cases of ventricular fibrillation (VF) and ventricular tachycardia (VT) are at high risk of fatal arrhythmias development and require alertness to prevent SCD. Nowadays new risk factors of SCD and effective methods aimed at the primary prevention of SCD are needed. Despite the high cost, implantable cardioverter-defibrillators (ICD) are considered to be important and effective for primary and secondary prevention of SCD. Although there is no specific evidence that the use of therapies focused on the control of risk factors mentioned above reduces the incidence of SCD, one may state the treatments oriented to the prevention of coronary atherosclerosis will reduce the incidence of ischemic myocardial injury, thus significantly affecting the risk of SCD. Many studies have provided data on the reduction of the risk of SCD when using antiplatelet agents, betablockers, inhibitors of angiotensin-converting enzyme. In a number of interesting observations decreased rate of VF and VT with long-term use of statins in patients with coronary artery disease were noted. Furthermore in studies with high risk patients included after the implantation of cardioverter-defibrillators a decrease in incidence of transient ventricular arrhythmias from 57 to 22 % was revealed with the administration of lipidlowering agents. Recent studies indicate a significant increase in survival of patients after myocardial revascularization. However, after the operation a risk of life-threatening arrhythmias in patients with a history of SCD remains still high. One of the major achievements in the prevention of SCD is the development of ICD. Currently, there is incontrovertible evidence of high efficacy of ICD in the prevention of SCD. The vast majority of studies on the efficacy of ICD in the primary and secondary prevention of SCD demonstrated the important role of their use in patients with coronary artery disease. The use of modern and effective methods of medical and surgical treatment properly will help to increase survival and improve the quality of life of this difficult group of patients.