Torp-Pedersen C, Køber L, Elming H, Burchart H
Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark.
Pacing Clin Electrophysiol. 1997 Oct;20(10 Pt 2):2545-52. doi: 10.1111/j.1540-8159.1997.tb06103.x.
Since all death is (eventually) sudden and associated with cardiac arrhythmias, the concept of sudden death is only meaningful if it is unexpected, while arrhythmic death is only meaningful if life could have continued had the arrhythmia been prevented or treated. Current classifications of death as being arrhythmic or sudden are all biased by the difficulty of having to decide on the degree of unexpectedness or the likelihood that life could continue without the arrhythmia. The uncertainties are enlarged by the fact that critical data (such as knowledge of arrhythmias at the time of death or autopsy) are available in only a few percent of cases. A main problem in using classifications is the lack of validation data. This situation has, with the MADIT trial, changed in the case of the Thaler and Hinkle classification of arrhythmic death. The MADIT trial demonstrated that arrhythmic death was nearly abolished by the implantable defibrillator, indicating that arrhythmic death by this classification is meaningful, at least in the population studied. For future investigations, a call is made for committees to present data in a way that allows the reader to examine the quality of the data used for evaluation.
由于所有死亡（最终）都是突然发生的且与心律失常相关，所以猝死的概念只有在意外发生时才有意义，而心律失常性死亡只有在心律失常能够被预防或治疗从而使生命得以延续时才有意义。目前将死亡分类为心律失常性或猝死性，都因难以确定意外程度或心律失常未发生时生命延续的可能性而存在偏差。仅在百分之几的病例中可获得关键数据（如死亡时或尸检时的心律失常情况），这一事实进一步加大了不确定性。使用这些分类的一个主要问题是缺乏验证数据。随着MADIT试验的开展，在心律失常性死亡的泰勒和欣克尔分类方面，这种情况发生了改变。MADIT试验表明，植入式除颤器几乎消除了心律失常性死亡，这表明按照这种分类，心律失常性死亡至少在所研究的人群中是有意义的。对于未来的研究，呼吁委员会以一种能让读者审视用于评估的数据质量的方式来呈现数据。
