Sudden cardiac death (SCD) remains a significant medical problem, accounting for 300,000 to 400,000 deaths annually in the United States.<sup>26 Cobb L.A., Werner J.A., Trobaugh G.B. Sudden cardiac death. I. A decade's experience with out-of-hospital resuscitation Mod Concepts Cardiovasc Dis 1980 ;  49 : 31-36

Cliquez ici pour aller à la section Références, 51 Kannel W.B., Thomas H.E. Sudden coronary death: The Framingham Study Ann NY Acad Sci 1982 ;  382 : 3-21  [cross-ref]

Cliquez ici pour aller à la section Références</sup> The incidence of SCD increases with advancing age because cardiovascular disease is more prevalent in the elderly.<sup>49 Kannel W.B., Cupples L.A., D'Agostino R.B. Sudden death risk in overt coronary heart disease: the Framingham Study Am Heart J 1987 ;  113 : 799  [cross-ref]

Cliquez ici pour aller à la section Références, 58 Kuller L., Lilienfield A. Epidemiological study of sudden and unexpected deaths due to arteriosclerotic heart disease Circulation 1966 ;  24 : 1056-1068

Cliquez ici pour aller à la section Références</sup> In most cases of SCD the metabolic substrate is myocardial ischemia from underlying coronary artery disease, hypertension, or hypertrophy, resulting in ventricular tachycardia (VT) or ventricular fibrillation (VF).<sup>62 McCance A.J. Autonomic nervous system and sudden death in coronary artery disease Progress in Cardiology Malvern, PA: Lea & Febiger (1992).  31-40

Cliquez ici pour aller à la section Références</sup> The underlying substrate for SCD is more common in the elderly because of the higher prevalence of coronary artery disease and hypertension, as well as physiologic changes in the myocardium with advancing age, which also predisposes to electrical instability.

Although the established principles of evaluation and management of cardiac arrhythmias apply to all age groups, management in the elderly patient is especially challenging because of increased risk of interventional and pharmacologic therapies, altered pharmacokinetics of drugs, and sometimes unclear long-term benefits in the older patient.