Sudden cardiac death (SCD), most often induced by ventricular arrhythmias, is one of the main reasons for cardiovascular-related mortality. While coronary artery disease remains the leading cause of SCD, other pathologies like cardiomyopathies and, especially in the younger population, genetic disorders, are linked to arrhythmia-related mortality. Despite many efforts to enhance the efficiency of risk-stratification strategies, effective tools for risk assessment are still missing. Biomarkers have a major impact on clinical practice in various cardiac pathologies. While classic biomarkers like brain natriuretic peptide (BNP) and troponins are integrated into daily clinical practice, inflammatory biomarkers may also be helpful for risk assessment. Indeed, several trials investigated their application for the prediction of arrhythmic events indicating promising results. Furthermore, in recent years, active research efforts have brought forward an increasingly large number of “novel and alternative” candidate markers of various pathophysiological origins. Investigations of these promising biological compounds have revealed encouraging results when evaluating the prediction of arrhythmic events. To elucidate this issue, we review current literature dealing with this topic. We highlight the potential of “classic” but also “novel” biomarkers as promising tools for arrhythmia prediction, which in the future might be integrated into clinical practice.

A 62-year-old pacemaker-dependent patient presented to our department with a sudden onset of reduced physical capacity. While initial physical and pacemaker evaluations remained without specific findings, Holter-ECG monitoring revealed an abnormal rate response with unusual pauses during physical exercise. Consequently, closer evaluation of the pacemaker system revealed intermittent, exercise-related T-wave oversensing (TWOS). While TWOS remains a significant burden in ICD-patients, it might be an underestimated but clinically significant event in pacemaker patients. Further studies should evaluate the impact of TWOS in this patient population.