[The problem of sudden death in heart failure]

Sudden death, due to malignant ventricular arrhythmias, is a major problem in heart failure. Mortality increases with NYHA functional class, but the relative percentage due to sudden death is higher in lower NYHA functional classes (50-80% in NYHA class II, 30-50% in NYHA class III, and 5-30% in NYHA class IV). No antiarrhythmic drug is useful to prevent sudden death. In coronary artery disease revascularization reduces mortality in multivessel disease. In all patients with heart failure many drugs are useful in reducing total mortality and sudden death: beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, antialdosterone drugs, statins, and omega-3 fatty acids. Finally, many prospective randomized studies have demonstrated the efficacy of implantable cardioverter-defibrillators in reducing mortality. However, the high cost-benefit ratio remains an unsolved problem of this therapy.