Management of survivors of out-of-hospital cardiac arrest

Sudden cardiac death is a major cause of death in the western world. Since a 1-year recurrence rate of 30% is expected in survivors of sudden death, treatment is mandatory. If an apparent cause (e.g. proarrhythmia or acute ischemia) exists, treatment is generally directed at its alleviation. However, in most patients no obvious cause is found. Both noninvasive and invasive diagnostic procedures are employed to uncover treatable etiologies. If a treatable cause is not found, an electrophysiological study may be employed to tailor antiarrhythmic therapy. At this point, many patients still cannot be offered an adequate antiarrhythmic treatment. For these patients, amiodarone, antiarrhythmic surgery or an implantable defibrillator may be appropriate options. Algorithms for diagnostic and therapeutic interventions in survivors of sudden cardiac death are delineated.