Prevention of sudden cardiac death: lessons from recent controlled trials.

Sudden cardiac death (SCD), presumably because of ventricular tachyarrhythmias, remains one of the major challenges of contemporary cardiology. Major randomized controlled trials conducted in patients with coronary artery disease (CAD) with the aim of primary prevention of SCD are providing insights. Several large-scale studies have demonstrated that treatment with beta-blockers, angiotensin-converting enzyme inhibitors, aldosterone antagonists, and statins results not only in a reduction in all-cause mortality but specifically also in SCD. On top of this optimized pharmacological therapy, implantable cardioverter-defibrillators (ICD) further decrease the risk of overall and SCD mortality in carefully selected patient groups. The sum of these trials indicates, however, that the benefit associated with ICD therapy is most prominent in patients with chronic stable CAD. In contrast, patients early after myocardial infarction derive less benefit from ICD treatment, presumably because of a high competing risk of non-arrhythmic cardiovascular death. Optimized pharmacological therapy, together with the ICD, can substantially improve the prognosis of high-risk CAD patients.