14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

RT-152

In search of the optimal algorithm for risk stratification of sudden cardiac death in the era of prophylactic ICD

Nabil El-Sherif, Gioia Turitto.
Cardiology Division, Department of Medicine, State University of New York, Health Science Center and Veterans Affairs Medical Center, Brooklyn, USA

In search for other risk stratifiers for SCD

In addition to the more commonly investigated techniques for risk stratification of SCD, several other risk indices have been reported. For instance, QT dispersion detected by magnetocardiograph³⁶ or by precordial mapping techniques³⁷ was reported to be a sensitive marker of the susceptibility to malignant VT. However, the prohibitive cost of a magnetocardiography laboratory and the technical demands of precordial mapping techniques are obvious deterrents to their wide application in a clinical setting. Beat-to-beat repolarization lability was found in one study to be a better identifier of SCD than other indicators of abnormal repolarization, including spatial QT dispersion and TWA³⁸. Low variability of cycle lengths of non-sustained VT was also suggested as an independent predictor of mortality after AMI³⁹. Increased heart rate, assessed from a 24-hour Holter recording, or even from a standard ECG tracing, was found to be a strong predictor of mortality after AMI^23,40. On the other hand, “non electrophysiologic” indices may also be associated with increased risk for SCD, for instance, LV mass and hypertrophy⁴¹.

The practical value of many of the risk stratifiers of SCD remains largely unanswered. Although risk stratification for SCD may be improved by using several variables in combination, one problem that has been alluded to is that dichotomous limits derived from univariate analysis may be different when used in the multivariate setting⁴².