Oliver M F
J Am Coll Cardiol. 1985 Jun;5(6 Suppl):150B-154B. doi: 10.1016/s0735-1097(85)80546-5.
There are many different and relatively discrete mechanisms leading to ventricular fibrillation. Therefore, any single approach to prevention is likely to be unsuccessful, particularly because the circumstances that finally cause sudden cardiac death may not be present for more than a short time before the onset of ventricular fibrillation. It should not be surprising, therefore, that neither primary nor secondary prevention trials directed at correcting risk factors for coronary heart disease have been associated with a reduction in the incidence of sudden cardiac death. More trials are needed in patients with unstable angina, in whom there is a relatively high incidence of sudden cardiac death within a short period. Methods of modulating catecholamine response, myocardial vulnerability and thrombotic mechanisms require more formal testing. However, because the sensitivity and specificity of prediction of those likely to die suddenly are so poor, it may become necessary to accept that the majority of sudden cardiac deaths is not yet preventable and focus on continuing to improve cardiopulmonary resuscitation services.
导致心室颤动的机制有许多不同且相对独立的类型。因此，任何单一的预防方法都可能不会成功，特别是因为最终导致心脏性猝死的情况可能在心室颤动发作前仅短时间内出现。所以，针对纠正冠心病危险因素的一级预防和二级预防试验均未使心脏性猝死的发生率降低，这并不令人惊讶。对于不稳定型心绞痛患者，需要开展更多试验，这类患者在短时间内心脏性猝死的发生率相对较高。调节儿茶酚胺反应、心肌易损性和血栓形成机制的方法需要进行更正规的测试。然而，由于预测哪些人可能会突然死亡的敏感性和特异性很差，可能有必要承认大多数心脏性猝死目前尚无法预防，并将重点继续放在改善心肺复苏服务上。
