[Importance and methods of evaluation of risks of malignant arrhythmias and sudden death]

Malignant arrhythmia and sudden death are one of the greatest challenges in cardiology. In prevention, it is important to correctly select patients under risk. Simple and non-invasive methods, by which we could make selection for invasive testing in wider population, need to get importance. The methods in risk stratification can be divided into classical and those recently accepted. Classical methods, which are mostly indirect methods, are echocardiography, exercise stress testing, Holter-ECG, coronary arteriography and electrophysiological testing. Predictive accuracy of classical methods is not satisfactory. This is the reason why new direct methods are developing. According to preliminary results they have better predictive accuracy. Accepted methods are analysis of late potentials and autonomic imbalance estimation, while in T wave alternans and QT interval dispersion some technical problems need to be resolved before routine application. Considering that these methods show various elements of arrhythmogenesis, the best predictive accuracy should be achieved by combination of all methods. But, before definite recommendation, this needs to be demonstrated in large prospective studies.