7 Local Social Influence Networks
7.2 How to explain individual understandings of citizenship: classic approaches
A pesar de los avances recientes en el manejo de la falla cardiaca, persiste una mortalidad alta, y más de 40% de las muertes son súbitas. Los pacientes que han sido reanimados de la muerte cardiaca súbita, permanecen en riesgo para la recurrencia de arritmias independientemente de la enfermedad cardiaca de base. Esto se demostró para pacientes con miocardiopatía dilatada idiopática e isquémica y aun en pacientes con corazones aparentemente normales. Los pacientes con fracción de eyección ventricular izquierda baja, tienen riesgo alto de muerte súbita cardiaca. Si la fracción de eyección es mayor a 0,40 el riesgo de muerte súbita es bajo. Ni las arritmias ventriculares ni cualquier otra variable, han demostrado servir para identificar los
pacientes con riesgo mayor para muerte cardiaca súbita que para muerte no súbita. El tratamiento actual para prevenir arritmias letales es inefectivo en la mayoría de los casos y puede ser pro-arrítmico. Por lo tanto, el cardiodesfibrilador implantable ha ganado aceptación amplia como tratamiento de elección para la taquicardia ventricular que comprometa la vida de los pacientes con función ventricular baja. Sin embargo, aún es controver- sial si la mortalidad cardiaca global puede mejorarse, especialmente en pacientes con estados avanzados de falla cardiaca.
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