Left ventricular hypertrophy, arterial hypertension and sudden death

Left ventricular hypertrophy has been identified as a powerful risk factor for sudden death and for general cardiovascular morbidity and mortality. Left ventricular hypertrophy has been documented as giving rise to ventricular ectopy, even in the absence of myocardial ischemia. Mechanisms of ectopic impulse generation in left ventricular hypertrophy are multifactorial and involve enlarged myocytes, focal areas of fibrosis, and subendocardial ischemia, as well as medial hypertrophy of the coronary arteries impeding homogeneous impulse propagation throughout the myocardium. Left ventricular hypertrophy can be reduced by specific antihypertensive therapy although not all antihypertensive agents are equally effective. A reduction of left ventricular hypertrophy with calcium antagonists, and possibly also with beta-blockers, has been shown to diminish ventricular arrhythmias. Whether or not such a reduction of left ventricular hypertrophy and suppression of ventricular ectopy will improve their unfavorable prognosis remains to be determined.