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Vasovagal syncope: Treat the patient, and not just the disease

  • Satish R. Raj
    Correspondence
    Corresponding author at: GAC70 HRIC Building, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta T2N 4Z6, Canada.
    Affiliations
    Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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  • Robert S. Sheldon
    Affiliations
    Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Published:September 21, 2022DOI:https://doi.org/10.1016/j.autneu.2022.103035
      The treatment of sudden cardiac (arrhythmic) death (SCD) was really revolutionized by the development of the implantable cardiac defibrillator (ICD). About 20 years ago, early randomized trials showing the efficacy of ICDs for the prevention of SCD in high-risk populations were published. This was an exciting time, and there was a sense that we could prevent most deaths from previously fatal dysrhythmia. It was in this environment that Dr. Robert Myerburg described a paradox (
      • Myerburg R.J.
      • Spooner P.M.
      Opportunities for sudden death prevention: directions for new clinical and basic research.
      ). ICDs were quite an effective treatment in individual patients at particularly high risk of SCD. This group, however, made up only a relatively small percentage of patients with SCD. Conversely, patients at a low individual risk of SCD made up the bulk of patients with SCD. The net effect was that ICD had a large effect on certain individual's risk of SCD, but a more modest effect on the population's risk of SCD. Modifying the population risk of SCD requires less intensive but more widespread therapies such as automatic external defibrillators and cardiovascular risk factor modification.
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