REVIEW ARTICLE
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Arrhythmic risk stratification in heart failure: Time for the next step?
Konstantinos A. Gatzoulis MD,
Antonios Sideris MD,
Emmanuel Kanoupakis MD,
Skevos Sideris MD,
Nikolaos Nikolaou MD,
Christos-Konstantinos Antoniou MD,
Theofilos M. Kolettis MD,
Corresponding Author
Konstantinos A. Gatzoulis MD
Electrophysiology Laboratory, First Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, Athens, Greece
Correspondence
Konstantinos A. Gatzoulis, Electrophysiology Laboratory, First Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Email: [email protected]
Search for more papers by this authorAntonios Sideris MD
Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
Search for more papers by this authorEmmanuel Kanoupakis MD
Department of Cardiology, University General Hospital of Heraklion, Heraklion, Greece
Search for more papers by this authorSkevos Sideris MD
State Department of Cardiology, “Hippokration” General Hospital, Athens, Greece
Search for more papers by this authorNikolaos Nikolaou MD
Department of Cardiology, “Konstantopouleio” General Hospital, Athens, Greece
Search for more papers by this authorChristos-Konstantinos Antoniou MD
Electrophysiology Laboratory, First Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, Athens, Greece
Search for more papers by this authorTheofilos M. Kolettis MD
Department of Cardiology, University General Hospital of Ioannina, Ioannina, Greece
Search for more papers by this authorKonstantinos A. Gatzoulis MD,
Antonios Sideris MD,
Emmanuel Kanoupakis MD,
Skevos Sideris MD,
Nikolaos Nikolaou MD,
Christos-Konstantinos Antoniou MD,
Theofilos M. Kolettis MD,
Corresponding Author
Konstantinos A. Gatzoulis MD
Electrophysiology Laboratory, First Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, Athens, Greece
Correspondence
Konstantinos A. Gatzoulis, Electrophysiology Laboratory, First Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Email: [email protected]
Search for more papers by this authorAntonios Sideris MD
Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
Search for more papers by this authorEmmanuel Kanoupakis MD
Department of Cardiology, University General Hospital of Heraklion, Heraklion, Greece
Search for more papers by this authorSkevos Sideris MD
State Department of Cardiology, “Hippokration” General Hospital, Athens, Greece
Search for more papers by this authorNikolaos Nikolaou MD
Department of Cardiology, “Konstantopouleio” General Hospital, Athens, Greece
Search for more papers by this authorChristos-Konstantinos Antoniou MD
Electrophysiology Laboratory, First Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, Athens, Greece
Search for more papers by this authorTheofilos M. Kolettis MD
Department of Cardiology, University General Hospital of Ioannina, Ioannina, Greece
Search for more papers by this authorAbstract
Background
Primary prevention of sudden cardiac death by means of implantable cardioverter-defibrillators constitutes the holy grail of arrhythmology. However, current risk stratification algorithms lead to suboptimal outcomes, by both allocating ICDs to patients not deriving any meaningful survival benefit and withholding them from those erroneously considered as low-risk for arrhythmic mortality.
Methods
In the present review article we will attempt to present shortcomings of contemporary guidelines regarding sudden death prevention in ischemic and dilated cardiomyopathy patients and present available data suggesting encouraging results following implementation of multifactorial approaches, by using multiple modalities, both noninvasive and invasive. Invasive electrophysiological testing, namely programmed ventricular stimulation, will be discussed in greater length to highlight both its potential usefulness and currently ongoing multicenter studies aiming to provide evidence necessary to make the next step in sudden death risk stratification.
Results
Promising findings have been reported by multiple study groups regarding novel strategies for both negative selection of low and positive selection of relatively preserved ejection fraction patients as candidates for ICD implantation.
Conclusions
The era of ejection fraction as the sole risk stratifier for arrhythmic risk in heart failure appears to be drawing to an end, especially if current underway large studies validate previous findings.
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