WASHINGTON, December 8, 2010 — The outcome of a recent expert consensus workshop, "NHLBI/HRS Workshop on Prediction and Prevention of Sudden Cardiac Death," identifies knowledge gaps and offers six specific research recommendations in high priority areas for sudden cardiac death (SCD) prediction and prevention. In the In the United States, SCD continues to claim more than 250,000 lives annually and is the cause of half of all heart disease deaths. The special report, Sudden Cardiac Death (SCD) Prediction and Prevention: Report from a National Heart, Lung and Blood Institute (NHLBI) and Heart Rhythm Society Workshop, was published in the November 30th issue of Circulation, an official journal of the American Heart Association.
The Heart Rhythm Society and the NHLBI partnered to hold a workshop of experts in cardiac electrophysiology on September 29-30, 2009, in Washington, D.C. The purpose of this workshop was to discover emerging approaches for improved prediction and prevention of SCD. The panel, consisting of two dozen arrhythmia investigators, was asked to consider the three broad areas of basic, clinical and population sciences. After deliberation on available information, as well as critical needs for SCD prediction and prevention, the group came to a consensus.
"With the support of HRS and NHLBI, the workshop provided a unique venue to tackle complex biomedical issues," said Glenn Fishman, MD, FHRS, at New York University. "It afforded experts the opportunity to challenge old concepts and debate new ideas, with the hope that our individual and collective creativity would provide a useful roadmap for future exploration."
The report outlines the outcomes of the expert consensus workshop – identifying knowledge gaps and a series of six specific recommendations for future research approaches in order to improve the prediction and prevention of SCD. Recommendations (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:
- Patients with ICD indications based on current guidelines
- Other patients at risk, such as:
- Coronary artery disease with left ventricular ejection fraction (EF) > 35%
- Early phase post acute myocardial infarction
- Heart failure with preserved systolic function
- Left ventricular hypertrophy
- Facilitate study of well-phenotyped SCD and control populations, including understudied subgroups.
- Establish standardized definitions, including of SCD
- Improve understanding of presenting arrhythmias, e.g. ventricular fibrillation, pulseless electrical activity, asystole
- Create opportunities for collaborative analysis of shared data
- Develop and validate a SCD risk score utilizing phenotypic, biologic and non-invasive markers.
- Establish strategies for SCD prevention that can be employed in the general population, targeting intermediate risk phenotypes.
The seriousness of SCD cannot be overstated and population studies will be necessary to make progress in this area. 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 Packer, president of the Heart Rhythm Society, MD, FHRS. "The Society is pleased to collaborate with the NHLBI and we will continue our efforts toward innovation in electrophysiology and the prevention of sudden death for years to come."
To view full text of the special report, please visit www.circ.ahajournals.org