Sudden cardiac death due to ventricular arrhythmia in diabetes mellitus: A bench to bedside review

Authors: Praloy Chakraborty, MD, Stanley Nattel, MD, Kumaraswamy Nanthakumar, MD, Kim A. Connelly, MD, Mansoor Husain, MD, Sunny S. Po, MD, Andrew C.T. Ha, MD.

Summary:

Narrative review that describes the contribution of diabetes to the pathophysiologic mechanism of sudden cardiac death (SCD) beyond its role in atherosclerotic cardiovascular disease and heart failure and outlines potential preventive and therapeutic strategies to mitigate the risk of SCD in this population of high-risk patients.

Key Findings:

Diabetes may induce electrophysiologic remodeling even without structural heart changes.

Structural remodeling is not required to increase SCD risk - 26% of sudden cardiac death (SCD) victims had no structural heart disease on autopsy.

Nocturnal SCD Risk: “Dead-in-bed” syndrome: SCD occurs predominantly at night. Occurs in patients with cardiac autonomic neuropathy (CAN).

Diabetes increases SCD incidence 3-4 fold in patients with stable coronary artery disease or prior myocardial infarction.

In heart failure, Diabetes further increases the incidence of ventricular arrhythmias and SCD.

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