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Pts with heart failure (HF) are at increased risk of sudden cardiac
death (SCD). This fact is not only a medical but also a great socio-economic problem. Despite of the significant
progress in treatment and prevention of cardiovascular diseases, the incidence and prevalence of HF have
been increasing especially in elderly. The most common cause of chronic HF as well as SCD is coronary artery
disease (CAD) in about 70% of pts. The most frequent cause of SCD in HF are malignant ventricular
arrhythmias, especially ventricular tachycardia caused by acute coronary event coupled with previous
myocardial damage and pump dysfunction. The degree of functional impairment classified by NYHA
classification is the simplest variable to predict overall mortality. Left ventricular dysfunction in term of ejection
fraction has been established as a major predictor of outcome in studies evaluating CAD, secondary
prevention of SCD as well as in multiple HF studies. Neurohormonal activity has also been related with the
prognosis. The signal averaged ECG may have value in predicting SCD in post-MI patients. Heart rate
variability is reduced in patients with congestive HF and could be a useful predictor of death.
Electrophysiologic studies have identified patients at higher risk for SCD in CAD group. Unfortunately, there
are no until now undisputedly accepted markers to identify the pts with HF who are most prone to die
suddenly. Concerning therapeutic strategies in HF to prevent SCD, data about ACE-inhibitors, beta-blockers
and amiodarone are well documented; ACE-inhibitors for preventing the progression of HF and CAD,
beta-blockers with relief of ischemia, reduction of heart rate and maintenance of favourable autonomic
balance, and amiodarone with its unique complex antiarrhythmic action. Implantable cardioverter-defibrillators
in pts with HF are effective and should be probably considered to less functional impaired patients with HF at
increased risk.
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