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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

What is the role of risk stratification for sudden death in the defibrillator era?

Werner Jung1,* and Burghard Schumacher2,*

1 Department of Cardiology, Academic Hospital Villingen, Vöhrenbacherstr. 23, 78050 Villingen-Schwenningen, Germany
2 Department of Cardiology, Clinic of Cardiovascular Medicine, Salzburger Leite 1, 97616 Bad Neustadt/Saale, Germany

* Corresponding authors. Tel: +49 7721 933001; fax: +49 7721 933099. E-mail address: werner.jung{at}sbk-vs.de (W.J.) Tel: +49 9771 66 2602; fax: +49 9771 66 2605.E-mail address: schumacher{at}kardiologie-bad-neustadt.de (B.S.)

Accurate and timely prediction of sudden cardiac death (SCD) is a necessary prerequisite for effective prevention and therapy. Although the largest numbers of SCD events occur in patients without overt heart disease, there are currently no tests that are of proven predictive value in this population. Efforts in risk stratification for SCD have focused primarily on predicting SCD in patients with known structural heart disease. Despite the ubiquity of tests that have been purported to predict SCD vulnerability in such patients, there is little consensus on which test, in addition to the left ventricular ejection fraction, should be used to select patients for implantable cardioverter defibrillators (ICDs). Effective therapy exists for SCD but it is costly and is associated with potential complications. Currently used strategies for selection of the best candidates for ICDs are imperfect and leave many high-risk patients unprotected. At the same time, some patients who receive ICDs will never develop ventricular tachyarrhythmia requiring ICD intervention. This article summarizes the current status and applicability of the non-invasive and invasive tests used for SCD risk assessment.

Key Words: Risk stratification • Sudden cardiac death • Implantable cardioverter defibrillator • Non-invasive tests


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