polyunsaturated fatty acids found in fish oil supplements (approximately 10 to 20 times the nutritional dose from fish) provide more protection than the intake of one to two servings of fatty fish (eg, salmon) per week. The pharmacologic use of fish oils supplements should be restricted to patients with refractory hypertriglyceridemia and, in such patients, the periodic monitoring of apolipoprotein B levels is recommended. (See "Healthy diet in adults" and "Hypertriglyceridemia in adults: Management", section on 'Treatment goals'.) Ischemic heart disease Patients who have ischemic heart disease, particularly those who have had an MI, are at an increased risk of SCA. However, among post-MI patients, this risk varies significantly according to a number of factors. The approach to the prevention of SCA in such patients includes the following: Standard medical therapies. Both beta blockers and ACE inhibitors (or angiotensin II receptor blockers) reduce overall mortality after an MI and are routinely administered. These agents also lower the incidence of SCD. However, the benefit may be limited to three years post MI. Beta blockers post-MI are useful for a longer period of time in patients with post-MI heart failure or ongoing chronic angina. (See "Primary prevention of sudden cardiac death in patients with cardiomyopathy and heart failure with reduced LVEF", section on 'Guideline-directed medical therapy' and "Acute myocardial infarction: Role of beta blocker therapy".) Risk stratification to identify those patients at the highest risk of SCA. (See "Incidence of and risk stratification for sudden cardiac death after myocardial infarction".) https://www.uptodate.com/contents/overview-of-sudden-cardiac-arrest-and-sudden-cardiac-death/print 13/32 7/6/23, 1:40 PM Overview of sudden cardiac arrest and sudden cardiac death - UpToDate ICD implantation in selected patients, ie, those with an ischemic cardiomyopathy and LVEF <35 percent. (See "Primary prevention of sudden cardiac death in patients with cardiomyopathy and heart failure with reduced LVEF".) Heart failure and cardiomyopathy Patients with heart failure and left ventricular systolic dysfunction, regardless of the etiology, are at an increased risk of SCA. Primary prevention with an ICD is recommended in selected patients with either ischemic or nonischemic cardiomyopathy, although recent studies have shown less if any benefit of an ICD in those with a nonischemic cardiomyopathy. (See "Primary prevention of sudden cardiac death in patients with cardiomyopathy and heart failure with reduced LVEF", section on 'Use of an ICD'.) In addition, as with patients with CHD, standard medical therapies for HF (beta blockers, ACE inhibitors or angiotensin II receptor blockers, and aldosterone inhibitors such as spironolactone or eplerenone) may lower the risk of SCA. (See "Ventricular arrhythmias: Overview in patients with heart failure and cardiomyopathy", section on 'Heart failure therapy'.) Inherited arrythmia syndromes Patients with one of the congenital disorders associated with an increased risk of SCA (eg, Brugada syndrome, congenital long QT syndrome, Wolff- Parkinson-White syndrome) are at increased risk for SCA. (See "Brugada syndrome: Clinical presentation, diagnosis, and evaluation" and "Congenital long QT syndrome: Epidemiology and clinical manifestations" and "Wolff-Parkinson-White syndrome: Anatomy, epidemiology, clinical manifestations, and diagnosis".) Counseling patients and families Given the mounting evidence related to the primary prevention of SCA, it now is clear that primary care clinicians can influence the occurrence of these events. As discussed above, there are clinical recommendations for those at risk of SCA that are likely to reduce risk. (See 'Risk factor reduction' above.) SECONDARY PREVENTION ICD therapy An implantable cardioverter-defibrillator (ICD) is the preferred therapeutic modality in most survivors of SCA. The ICD does not prevent the recurrence of malignant ventricular arrhythmias, but it effectively terminates these arrhythmias when they do recur. The role of the ICD in survivors of SCA is presented separately. (See "Secondary prevention of sudden cardiac death in heart failure and cardiomyopathy".) ICD patients who have frequent arrhythmia recurrences and device discharges may benefit from adjunctive therapies, such as antiarrhythmic drugs or catheter ablation. (See "Secondary prevention of sudden cardiac death in heart failure and cardiomyopathy", section on https://www.uptodate.com/contents/overview-of-sudden-cardiac-arrest-and-sudden-cardiac-death/print 14/32 7/6/23, 1:40 PM Overview of sudden cardiac arrest and sudden cardiac death - UpToDate 'Antiarrhythmic drugs' and "Pharmacologic therapy in survivors of sudden cardiac arrest", section on 'Treatment of breakthrough arrhythmias' and "Sustained monomorphic ventricular tachycardia in patients with structural heart disease: Treatment and prognosis", section on 'Radiofrequency catheter ablation'.) Other antiarrhythmic therapies Antiarrhythmic drugs are less effective than an ICD for secondary prevention of SCD. Thus, their use in this setting is limited to the adjunctive role described above, or in patients who do not want or are not candidates for an ICD (eg, due to marked comorbidities or end-stage heart failure that make death likely). Patients in whom ventricular arrhythmias result in recurrent shocks despite antiarrhythmic medications may be candidates for catheter ablation in an effort to reduce the arrhythmic burden. (See "Pharmacologic therapy in survivors of sudden cardiac arrest" and "Sustained monomorphic ventricular tachycardia in patients with structural heart disease: Treatment and prognosis", section on 'Radiofrequency catheter ablation'.) INFORMATION FOR PATIENTS UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." th th The Basics patient education pieces are written in plain language, at the 5 to 6 grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more th th sophisticated, and more detailed. These articles are written at the 10 to 12 grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon. Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.) Basics topics (see "Patient education: Sudden cardiac arrest (The Basics)") SUMMARY AND RECOMMENDATIONS The following summary and recommendations address general issues related to sudden cardiac arrest (SCA) and sudden cardiac death (SCD). https://www.uptodate.com/contents/overview-of-sudden-cardiac-arrest-and-sudden-cardiac-death/print 15/32 7/6/23, 1:40 PM Overview of sudden cardiac arrest and sudden cardiac death - UpToDate Background SCA and SCD refer to the sudden cessation of cardiac activity with hemodynamic collapse. Events that are successfully treated with patient survival are referred to as SCA, while those that lead to death are referred to as SCD. (See 'Definitions' above.) Epidemiology SCD is common, accounting for up to 15 percent of total mortality in industrialized countries, based upon review of death certificate data. Smaller prospective studies, however, have suggested a lower incidence. (See 'Epidemiology' above.) Etiology SCA is most commonly due to ventricular tachyarrhythmias (ie, ventricular fibrillation or ventricular tachycardia). The risk of such arrhythmic events is increased in patients with coronary heart disease or other forms of structural heart disease. In patients with hearts that appear structurally normal, relatively uncommon primary arrhythmia syndromes can cause SCA. (See 'Etiology' above and "Approach to sudden cardiac arrest in the absence of apparent structural heart disease".) Risk factors The risk factors for SCA are similar to those for coronary heart disease. (See 'Risk factors' above.) Management The acute management of SCA involves standard cardiopulmonary resuscitation protocols. (See "Advanced cardiac life support (ACLS) in adults".) Primary prevention A heart-healthy lifestyle, including habitual physical activity, a heart- healthy diet, and abstinence or cessation of cigarette smoking, is recommended for the primary prevention of SCD. General population without known cardiac disease: Apart from standard screening and management of risk factors for CHD (eg, measurement of lipids, BP, and glucose), in patients without known cardiac disease we recommend no additional screening tests or treatment for the purpose of primary prevention of SCD (Grade 1B). (See 'General population' above.) Preparticipation screening of athletes for the purpose of preventing SCD is a unique issue that is discussed in detail separately. (See "Screening to prevent sudden cardiac death in competitive athletes".) Patients with known cardiac disease (eg, prior MI, cardiomyopathy, or heart failure) are at an increased risk of SCA. (See 'Ischemic heart disease' above and 'Heart failure and cardiomyopathy' above.) https://www.uptodate.com/contents/overview-of-sudden-cardiac-arrest-and-sudden-cardiac-death/print 16/32 7/6/23, 1:40 PM Overview of sudden cardiac arrest and sudden cardiac death - UpToDate The approach to the primary prevention of SCA in such patients includes the following: Standard medical therapies that lower the incidence of SCA. (See "Ventricular arrhythmias: Overview in patients with heart failure and cardiomyopathy", section on 'Heart failure therapy' and "Primary prevention of sudden cardiac death in patients with cardiomyopathy and heart failure with reduced LVEF", section on 'Guideline-directed medical therapy'.) Testing for the purpose of SCA risk stratification in selected subgroups. (See "Incidence of and risk stratification for sudden cardiac death after myocardial infarction".) ICD implantation in selected patients. (See "Ventricular arrhythmias: Overview in patients with heart failure and cardiomyopathy", section on 'Prevention of SCD' and "Primary prevention of sudden cardiac death in patients with cardiomyopathy and heart failure with reduced LVEF".) Secondary prevention Management of survivors of SCA includes the identification and treatment of acute reversible causes, evaluation for structural heart disease and/or primary electrical diseases, neurologic and psychologic assessment, and evaluation of family members in selected cases. (See "Cardiac evaluation of the survivor of sudden cardiac arrest".) Secondary prevention of SCD, usually with an ICD, is appropriate for most SCA survivors. (See "Secondary prevention of sudden cardiac death in heart failure and cardiomyopathy".) 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The incidence of primary cardiac arrest during vigorous exercise. N Engl J Med 1984; 311:874. 28. Trichopoulos D, Katsouyanni K, Zavitsanos X, et al. Psychological stress and fatal heart attack: the Athens (1981) earthquake natural experiment. Lancet 1983; 1:441. 29. Kark JD, Goldman S, Epstein L. Iraqi missile attacks on Israel. The association of mortality with a life-threatening stressor. JAMA 1995; 273:1208. 30. Siscovick DS, Raghunathan TE, King I, et al. Dietary intake and cell membrane levels of long- chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. JAMA 1995; 274:1363. 31. Kannel WB, Thomas HE Jr. Sudden coronary death: the Framingham Study. Ann N Y Acad Sci 1982; 382:3. https://www.uptodate.com/contents/overview-of-sudden-cardiac-arrest-and-sudden-cardiac-death/print 19/32 7/6/23, 1:40 PM Overview of sudden cardiac arrest and sudden cardiac death - UpToDate 32. Jouven X, Desnos M, Guerot C, Ducimeti re P. Predicting sudden death in the population: the Paris Prospective Study I. Circulation 1999; 99:1978. 33. Sandhu RK, Jimenez MC, Chiuve SE, et al. Smoking, smoking cessation, and risk of sudden cardiac death in women. Circ Arrhythm Electrophysiol 2012; 5:1091. 34. Albert CM, Mittleman MA, Chae CU, et al. Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med 2000; 343:1355. 35. Lemaitre RN, Siscovick DS, Raghunathan TE, et al. Leisure-time physical activity and the risk of primary cardiac arrest. Arch Intern Med 1999; 159:686. 36. Maron BJ, Carney KP, Lever HM, et al. Relationship of race to sudden cardiac death in competitive athletes with hypertrophic cardiomyopathy. J Am Coll Cardiol 2003; 41:974. 37. Corrado D, Basso C, Schiavon M, Thiene G. Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med 1998; 339:364. 38. Norby FL, Reinier K, Uy-Evanado A, et al. Sudden Cardiac Death in Patients With Type 1 Versus Type 2 Diabetes. Mayo Clin Proc 2022; 97:2271. 39. Albert CM, Ma J, Rifai N, et al. Prospective study of C-reactive protein, homocysteine, and plasma lipid levels as predictors of sudden cardiac death. Circulation 2002; 105:2595. 40. Tu SJ, Gallagher C, Elliott AD, et al. Alcohol consumption and risk of ventricular arrhythmias and sudden cardiac death: An observational study of 408,712 individuals. Heart Rhythm 2022; 19:177. 41. Albert CM, Manson JE, Cook NR, et al. Moderate alcohol consumption and the risk of sudden cardiac death among US male physicians. Circulation 1999; 100:944. 42. Weinmann S, Siscovick DS, Raghunathan TE, et al. Caffeine intake in relation to the risk of primary cardiac arrest. Epidemiology 1997; 8:505. 43. Jouven X, Charles MA, Desnos M, Ducimeti re P. Circulating nonesterified fatty acid level as a predictive risk factor for sudden death in the population. Circulation 2001; 104:756. 44. Djouss L, Biggs ML, Ix JH, et al. Nonesterified fatty acids and risk of sudden cardiac death in older adults. Circ Arrhythm Electrophysiol 2012; 5:273. 45. Lemaitre RN, King IB, Raghunathan TE, et al. Cell membrane trans-fatty acids and the risk of primary cardiac arrest. Circulation 2002; 105:697. 46. Harper CR, Jacobson TA. The fats of life: the role of omega-3 fatty acids in the prevention of coronary heart disease. Arch Intern Med 2001; 161:2185. 47. Albert CM, Campos H, Stampfer MJ, et al. Blood levels of long-chain n-3 fatty acids and the risk of sudden death. N Engl J Med 2002; 346:1113. https://www.uptodate.com/contents/overview-of-sudden-cardiac-arrest-and-sudden-cardiac-death/print 20/32 7/6/23, 1:40 PM Overview of sudden cardiac arrest and sudden cardiac death - UpToDate 48. Daviglus ML, Stamler J, Orencia AJ, et al. Fish consumption and the 30-year risk of fatal myocardial infarction. N Engl J Med 1997; 336:1046. 49. Priori SG, Aliot E, Blomstrom-Lundqvist C, et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology. Eur Heart J 2001; 22:1374. 50. De Backer G, Kornitzer M, Dramaix M, et al. The Belgian Heart Disease Prevention Project: 10-year mortality follow-up. Eur Heart J 1988; 9:238. 51. Wannamethee G, Shaper AG. Alcohol and sudden cardiac death. Br Heart J 1992; 68:443. 52. Shephard RJ, Balady GJ. Exercise as cardiovascular therapy. Circulation 1999; 99:963. 53. Kromhout D, Bosschieter EB, de Lezenne Coulander C. The inverse relation between fish consumption and 20-year mortality from coronary heart disease. N Engl J Med 1985; 312:1205. 54. Albert CM, Hennekens CH, O'Donnell CJ, et al. Fish consumption and risk of sudden cardiac death. JAMA 1998; 279:23. 55. Marchioli R, Barzi F, Bomba E, et al. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI)- Prevenzione. Circulation 2002; 105:1897. 56. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico. Lancet 1999; 354:447. Topic 963 Version 33.0 https://www.uptodate.com/contents/overview-of-sudden-cardiac-arrest-and-sudden-cardiac-death/print 21/32 7/6/23, 1:40 PM Overview of sudden cardiac arrest and sudden cardiac death - UpToDate GRAPHICS Major causes of sudden death Ischemic heart disease Coronary artery disease with myocardial infarction or angina Coronary artery embolism Nonatherogenic coronary artery disease (arteritis, dissection, congenital coronary artery anomalies) Coronary artery spasm Nonischemic heart disease Hypertrophic cardiomyopathy Dilated cardiomyopathy Valvular heart disease Congenital heart disease Arrhythmogenic right ventricular dysplasia Myocarditis Acute pericardial tamponade Acute myocardial rupture Aortic dissection No structural heart disease Primary electrical disease (idiopathic ventricular fibrillation) Brugada syndrome (right bundle branch block and ST segment elevation in leads V1 to V3) Long QT syndrome Preexcitation syndrome Complete heart block Familial sudden cardiac death Chest wall trauma (commotio cordis) Noncardiac disease Pulmonary embolism Intracranial hemorrhage Drowning Pickwickian syndrome https://www.uptodate.com/contents/overview-of-sudden-cardiac-arrest-and-sudden-cardiac-death/print 22/32 7/6/23, 1:40 PM Overview of sudden cardiac arrest and sudden cardiac death - UpToDate Drug-induced Central airway obstruction Sudden infant death syndrome Sudden unexplained death in epilepsy (SUDEP) Graphic 62184 Version 3.0 https://www.uptodate.com/contents/overview-of-sudden-cardiac-arrest-and-sudden-cardiac-death/print 23/32 7/6/23, 1:40 PM Overview of sudden cardiac arrest and sudden cardiac death - UpToDate ECG 12-lead ventricular fibrillation 12-lead ECG showing course ventricular fibrillation. ECG: electrocardiogram. Graphic 118944 Version 1.0 https://www.uptodate.com/contents/overview-of-sudden-cardiac-arrest-and-sudden-cardiac-death/print 24/32 7/6/23, 1:40 PM Overview of sudden cardiac arrest and sudden cardiac death - UpToDate Incidence of sudden death in men and women increases with age During a 38-year follow-up of subjects in the Framingham Heart Study, the annual incidence of sudden death increased with age in both men and women. However, at each age, the incidence of sudden death is higher in men than women. Data from Kannel WB, Wilson PWF, D'Agostino RB, et al. Am Heart J 1998; 136:205. Graphic 59028 Version 4.0 https://www.uptodate.com/contents/overview-of-sudden-cardiac-arrest-and-sudden-cardiac-death/print 25/32 7/6/23, 1:40 PM Overview of sudden cardiac arrest and sudden cardiac death - UpToDate Risk of SCD is related to clinical manifestations of CHD During a 38-year follow-up of subjects in the Framingham Heart Study, the annual incidence of sudden cardiac death (SCD) in both men and women was related to the clinical manifestations of coronary heart disease (CHD). It was highest in those with a myocardial infarction, intermediate in those with angina and no prior infarction, and lowest in those without overt CHD. Data from: Kannel WB, Wilson PWF, D'Agostino RB, et al. Am Heart J 1998; 136:205. Graphic 52309 Version 2.0 https://www.uptodate.com/contents/overview-of-sudden-cardiac-arrest-and-sudden-cardiac-death/print 26/32 7/6/23, 1:40 PM Overview of sudden cardiac arrest and sudden cardiac death - UpToDate Some reported causes and potentiators of the long QT syndrome Congenital Jervell and Lange-Nielsen syndrome (including "channelopathies") Romano-Ward syndrome Idiopathic Acquired Metabolic disorders Other factors Androgen deprivation therapy Hypokalemia Myocardial GnRH agonist/antagonist therapy ischemia or infarction, Hypomagnesemia Bilateral surgical orchiectomy Hypocalcemia Diuretic therapy via electrolyte disorders especially with Starvation particularly hypokalemia and hypomagnesemia prominent T-wave inversions Anorexia nervosa Herbs Liquid protein diets Cinchona (contains quinine), iboga (ibogaine), licorice extract in overuse via electrolyte disturbances Intracranial disease Hypothyroidism Bradyarrhythmias HIV infection Sinus node dysfunction Hypothermia Toxic exposure: Organophosphate insecticides AV block: Second or third degree Medications* High risk Adagrasib Cisaparide Lenvatinib Selpercatinib (restricted availability) Ajmaline Levoketoconazole Sertindole Amiodarone Methadone Sotalol Delamanid Arsenic trioxide Mobocertinib Terfenadine Disopyramide Astemizole Papavirine Vandetanib Dofetilide (intracoronary) Bedaquline Vernakalant Dronedarone Procainamide Bepridil Ziprasidone Haloperidol (IV) Quinidine Chlorpromazine Ibutilide Quinine Ivosidenib Moderate risk Amisulpride (oral) Droperidol Inotuzumab ozogamacin Propafenone Azithromycin Encorafenib Propofol Isoflurane Capecitabine Entrectinib Quetiapine Carbetocin Erythromycin Ribociclib https://www.uptodate.com/contents/overview-of-sudden-cardiac-arrest-and-sudden-cardiac-death/print 27/32 7/6/23, 1:40 PM Overview of sudden cardiac arrest and sudden cardiac death - UpToDate Certinib Escitalopram Levofloxacin Risperidone (systemic) Chloroquine Etelcalcetide Saquinavir Lofexidine Citalopram Fexinidazole Sevoflurane Meglumine Clarithromycin Flecainide Sparfloxacin antimoniate Clofazimine Floxuridine Sunitinib Midostaurin Clomipramine Fluconazole Tegafur Moxifloxacin Clozapine Fluorouracil Terbutaline Nilotinib (systemic) Crizotinib Thioridazine Olanzapine Flupentixol Dabrafenib Toremifene Ondansetrol (IV > Gabobenate dimeglumine Dasatinib Vemurafenib oral) Deslurane Voriconazole Osimertinib Gemifloxacin Domperidone Oxytocin Gilteritinib Doxepin Pazopanib Halofantrine Doxifluridine Pentamidine Haloperidol (oral) Pilsicainide Imipramine Pimozide Piperaquine Probucol Low risk Albuterol Fingolimod Mequitazine Ranolazine (due to bradycardia) Alfuzosin Fluoxetine Methotrimeprazine Relugolix Amisulpride (IV) Fluphenazine Metoclopramide (rare reports) Rilpivirine Amitriptyline Formoterol Metronidazole (systemic) Romidepsin Anagrelide Foscarnet Roxithromycin Apomorphine Fostemsavir Mifepristone Salmeterol Arformoterol Gadofosveset Mirtazapine Sertraline Artemether- Glasdegib Mizolastine lumefantrine Siponimod Goserelin Nelfinavir Asenapine Solifenacin Granisetron Norfloxacin Atomoxetine Sorafenib Hydroxychloroquine Nortriptyline Benperidol (rare reports) Sulpiride Ofloxacin (systemic) Bilastine Hydroxyzine Tacrolimus Olodaterol (systemic) Bosutinib Iloperidone Osilodrostat Tamoxifen Bromperidol Indacaterol Oxaliplatin Telavancin Buprenorphine Itraconazole Ozanimod Telithromycin Buserelin Ketoconazole (systemic) Pacritinib Teneligliptin Ciprofloxacin (Systemic) Lacidipine Paliperidone Tetrabenazine Cocaine (Topical) Lapatinib Panobinostat Trazodone Degarelix Lefamulin Pasireotide Triclabendazole https://www.uptodate.com/contents/overview-of-sudden-cardiac-arrest-and-sudden-cardiac-death/print 28/32 7/6/23, 1:40 PM Overview of sudden cardiac arrest and sudden cardiac death - UpToDate Desipramine Leuprolide Pefloxacin Triptorelin Deutetrabenazine Leuprolide- Periciazine Tropisetron norethindrone Dexmedetomidine** Pimavanserin Vardenafil Levalbuterol Dolasetron Pipamperone Vilanterol Levomethadone Donepezil Pitolisant Vinflunine Lithium Efavirenz Ponesimod Voclosporin Loperamide overdose in Eliglustat Primaquine Vorinostat Eribulin Promazine Zuclopenthixol Lopinavir Ezogabine Radotinib Macimorelin Mefloquine This is not a complete list of all corrected QT interval (QTc)-prolonging drugs and does not include drugs with either a minor degree or isolated association(s) with QTc prolongation that appear to be safe in most patients but may need to be avoided in patients with congenital long QT syndrome depending upon clinical circumstances. A more complete list of such drugs is available at the CredibleMeds website. For clinical use and precautions related to medications and drug interactions, refer to the UpToDate topic review of acquired long QT syndrome discussion of medications and the Lexicomp drug interactions tool. AV: atrioventricular; IV: intravenous; QTc: rate-corrected QT interval on the electrocardiogram. Classifications provided by Lexicomp according to US Food & Drug Administration guidance: Clinical Evaluation of QT/QTc Interval Prolongation and Proarrhythic Potential for Non-Antiarrhythmic Drugs Questions and Answers; Guidance for Industry US Food and Drug Administration, June 2017 (revision 2) available at: https://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM 073161.pdf with additional data from CredibleMeds QT drugs list criteria may lead to some agents being classified differently by other sources. [1,2] . The use of other classification Not available in the United States. In contrast with other class III antiarrhythmic drugs, amiodarone is rarely associated with torsades de pointes; refer to accompanying text within UpToDate topic reviews of acquired long QT syndrome. Withdrawn from market in most countries due to adverse cardiovascular effects. IV amisulpride antiemetic use is associated with less QTc prolongation than the higher doses administered orally as an antipsychotic. Other cyclic antidepressants may also prolong the QT interval; refer to UpToDate clinical topic on cyclic antidepressant pharmacology, side effects, and separate UpToDate topic on tricyclic antidepressant poisoning. The "low risk" category includes drugs with limited evidence of clinically significant QTc prolongation or TdP risk; many of these drugs have label warnings regarding possible QTc effects or recommendations to avoid use or increase ECG monitoring when combined with other QTc prolonging drugs. https://www.uptodate.com/contents/overview-of-sudden-cardiac-arrest-and-sudden-cardiac-death/print 29/32 7/6/23, 1:40 PM Overview of sudden cardiac arrest and sudden cardiac death - UpToDate Rarely associated with significant QTc prolongation at usual doses for treatment of opioid use disorder, making buprenorphine a suitable alternative for patients with methadone-associated QTc prolongation. Refer to UpToDate clinical topic reviews. * The United States FDA labeling for the sublingual preparation of dexmedetomidine warns against use in patients at elevated risk for QTc prolongation. Both intravenous (ie, sedative) and sublingual formulations of dexmedetomidine have a low risk of QTc prolongation and have not been implicated in TdP. Over-the-counter; available without a prescription. Not associated with significant QTc prolongation in healthy persons. Refer to UpToDate clinical topic for potential adverse cardiovascular (CV) effects in patients with CV disease. Data from: 1. Lexicomp Online. Copyright 1978-2023 Lexicomp, Inc. All Rights Reserved. 2. CredibleMeds QT drugs list website sponsored by Science Foundation of the University of Arizona. Available at http://crediblemeds.org/. Graphic 57431 Version 142.0 https://www.uptodate.com/contents/overview-of-sudden-cardiac-arrest-and-sudden-cardiac-death/print 30/32 7/6/23, 1:40 PM Overview of sudden cardiac arrest and sudden cardiac death - UpToDate Additive effects of risk factors on cardiovascular disease at 5 years Cumulative absolute risk of CVD at 5 years according to systolic blood pressure and specified levels of other risk factors. The reference category is a non-diabetic, non-smoking 50-year-old woman with a serum TC of 154 mg/dL (4.0 mmol/L) and HDL cholesterol of 62 mg/dL (1.6 mmol/L). The CVD risks are given for systolic blood pressure levels of 110, 130, 150, and 170 mmHg. In the other categories, the additional risk factors are added consecutively. As an example, the diabetes category is a 50-year-old diabetic man who is a smoker and has a TC of 270 mg/dL (7 mmol/L) and HDL cholesterol of 39 mg/dL (1 mmol/L). BP: blood pressure; CVD: cardiovascular disease; HDL: high-density lipoprotein; TC: total cholesterol. Adapted from: Jackson R, Lawes CM, Bennett DA, et al. Lancet 2005; 365:434. Graphic 55353 Version 12.0 https://www.uptodate.com/contents/overview-of-sudden-cardiac-arrest-and-sudden-cardiac-death/print 31/32 7/6/23, 1:40 PM Overview of sudden cardiac arrest and sudden cardiac death - UpToDate Contributor Disclosures Philip J Podrid, MD, FACC No relevant financial relationship(s) with ineligible companies to disclose. Brian Olshansky, MD Other Financial Interest: AstraZeneca [Member of the DSMB for the DIALYZE trial]; Medtelligence [Cardiovascular disease]. All of the relevant financial relationships listed have been mitigated. Scott Manaker, MD, PhD Other Financial Interest: Expert witness in workers' compensation and in medical negligence matters [General pulmonary and critical care medicine]; National Board for Respiratory Care [Director]. All of the relevant financial relationships listed have been mitigated. Nisha Parikh, MD, MPH No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/overview-of-sudden-cardiac-arrest-and-sudden-cardiac-death/print 32/32