Use of drugs for recurrent VT - not very effective

If the patient has history of recurrent VT, the most effective treatment is Implantable cardioverter defibrillator (ICD).

Patient with malignant ventricular fibrillation

Risk of certain cardiac death with :

• anti-arrhythmic drug is 20-40%
• Amiodarone 10-20%
• ICD 2%

Primary prevention of sudden cardiac death in older age group

This involves the identification of high risk population.

In the older age group, the coronary artery disease remains the biggest risk factor. The 5 major risk factors of coronary artery disease are:

1. Family history.
2. Hyperlipidaemia.
3. Hypertension.
4. Diabetes.
5. Smoking.

If anyone with two or more of these risk factors should be assessed to see the underlying coronary artery disease. The investigations would probably include:

• ECG
• Treadmill Stress Test
• 64-sliced CT coronary angiogram
• Radio Isotope Perfusion Stress Test
• Coronary angiogram with or without IVUS. This is still the gold standard for the diagnosis of coronary artery disease.

Primary prevention of sudden cardiac death in the younger age group:

Unless there is a family history of sudden cardiac death, it is not feasible to screen everyone for underlying heart disease. We have to exclude all the causes stated previously. This would probably involve ECG, Treadmill Stress Test, 2D echo examination of the heart and if necessary Electrophysiological Study (EPS). When the cause is identified then it is possible to prevent SCD in some cases.