Letter: Left circumflex coronary artery in SCS.
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Biomedical subjects
Publications and source records attributed to R H Peter.
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A case of ventricular aneurysm with refractory ventricular tachycardia is presented. Epicardial mapping was used to localize the site of earliest epicardial activity to the margin of the aneurysm, and subsequent resection of this area abolished the rhythm disturbance.
The authors followed 536 medically managed patients with angiographically documented coronary artery disease for up to 4 years, and examined antemortem clinical, anatomical, and hemodynamic characteristics of the 29 patients who died suddenly during the follow-up period. These patients are compared in terms of hemodynamic characteristics to those who survived and those who died non-suddenly of coronary heart disease. Of the 29 patients who died suddenly, more than 80% had evidence of moderate to severe impairment of myocardial function many months prior to death. Only a single patient had the combination of relatively mild coronary artery disease and normal ventricular function. This single patient would be the ultimate target of a program designed to prevent sudden death. However, it has been necessary to follow 536 patients with angiographically documented coronary artery disease in order to find this one potential benefactor of sudden death prophylaxis. This study demonstrates that there are patients with coronary artery disease who die suddenly, despite relatively mild disease; however, these patients appear to represent only a small proportion of all sudden deaths.
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