Diabetes and arrhythmic risk: mechanisms and clinical evidence, early response with cardioprotection

Abstract

Sudden cardiac death (SCD) is a leading cause of cardiovascular mortality, and diabetes multiplies its risk 2–4-fold through disease-specific mechanisms: accelerated coronary disease with silent ischemia, cardiac autonomic neuropathy (reduced heart-rate variability, sympathetic predominance), diabetic cardiomyopathy with fibrosis, and electrical abnormalities (QT prolongation and dispersion, late afterdepolarizations, torsade-de-pointes susceptibility). Clinical risk stratification —LVEF <35 %, autonomic neuropathy, MRI fibrosis, Holter arrhythmias— identifies implantable-defibrillator candidates; yet a substantial share of fatal events occur without prior diagnosis or implant criteria, and the first manifestation is often out-of-hospital cardiac arrest. This underscores community cardioprotection: the chain of survival, early bystander CPR, and prompt AED defibrillation, which achieves 70–80 % survival in ventricular fibrillation when delivered within the first minutes. Argentina's legal framework (Law 27.159, ReNaDEAs registry), cardioprotected spaces, and population-wide CPR training are integrated as public-health policy.

In conclusion: preventing SCD in diabetes demands both a clinical and a community response — the two are inseparable.