Evaluation and management of sudden death survivors

Only 20% of patients survive a cardiac arrest. Up to 80% of patients have a cardiac arrest secondary to a ventricular tachyarrhythmia. In the adult population, over 70% of the above patients have obstructive coronary artery disease, thus, coronary arteriography should be performed in all survivors of cardiac arrest. Once reversible causes have been treated, antiarrhythmic therapy is usually guided by Holter monitoring, electrophysiologic testing or both. Due to high recurrence rates on antiarrhythmic drugs, many patients are now treated with implantable cardioverter defibrillators. Although these devices appear to improve sudden death survival, long-term overall survival may not be superior to 'best drug therapy.' This hypothesis is currently being tested in two prospective randomized, multicenter trials.