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Risk Stratification for Sudden Cardiac Death: The Need to Go Beyond the Left Ventricular Ejection Fraction

Devi Gopinath1, Otto Costantini2

  • 1Heart and Vascular Center, MetroHealth Campus, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109-1998, USA.

Cardiac Electrophysiology Clinics
|August 4, 2017
PubMed

Insights

Sudden cardiac death (SCD) risk stratification is crucial for deciding on implantable cardioverter-defibrillator (ICD) use. This review examines promising noninvasive electrophysiological markers to improve patient selection for ICDs.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Preventive Medicine

Background:

  • Sudden cardiac death (SCD) causes significant mortality, with implantable cardioverter-defibrillators (ICDs) proven effective in high-risk patients.
  • Current patient selection for ICDs primarily relies on low left ventricular ejection fraction (LVEF), but identifying optimal candidates remains challenging.

Purpose of the Study:

  • To review promising noninvasive electrophysiological markers for SCD risk stratification.
  • To assess the clinical significance and potential of these markers in improving prophylactic ICD implant efficacy.

Main Methods:

  • Review of clinical trials and studies on electrophysiological markers for SCD risk.
  • Analysis of the predictive value and prospective testing of various noninvasive markers.

Main Results:

  • Previous ICD trials utilized abnormal electrophysiological studies and low LVEF; newer trials focus on low LVEF alone.
  • Several noninvasive electrophysiological markers show association with SCD risk but have yielded inconsistent results or lack prospective validation.

Conclusions:

  • Improved noninvasive electrophysiological markers are needed for more precise risk stratification in patients considered for ICDs.
  • Further prospective studies are essential to validate these markers and optimize their use in clinical decision-making for SCD prevention.

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