Arrhythmic risk stratification in heart failure: Time for the next step?

Abstract

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.

Signal‐averaged electrocardiography: Past, present, and future

“…24 The value of SAECG, incorporated in risk-stratification strategies, is further underscored by a recent study 25 Current evidence indicates that multifactorial approaches are also pertinent among DCM patients, encompassing invasive and noninvasive indices. 3 SAECG holds a place in this respect, as shown by early clinical reports, where SAECG could discriminate those DCM patients with a history of VT from those without, 29 albeit with an inferior predictive value compared to MI patients. 30 In keeping with these findings, one-year event-free survival was 95% in a larger cohort of DCM patients with absence of LPs, contrasting the only 39% in patients with an abnormal SAECG 31 ; of note, multivariate analysis in this study demonstrated that SAECG and functional class were independent predictors of survival.…”

“…Current evidence indicates that multifactorial approaches are also pertinent among DCM patients, encompassing invasive and noninvasive indices . SAECG holds a place in this respect, as shown by early clinical reports, where SAECG could discriminate those DCM patients with a history of VT from those without, albeit with an inferior predictive value compared to MI patients .…”

“…Resulting from this complex pathophysiology, risk stratification remains a challenge in these patients, with several concerns raised on the value of arrhythmic markers in DCM; actually, many centers often omit the electrophysiologic evaluation in DCM, opting to use LVEF as a sole criterion. However, the widespread skepticism on this practice was fueled by the recent DANISH trial, in which 556 patients with LVEF ≤35% were assigned to receive an ICD and 560 patients to standard care; after a median follow‐up period of 67.6 months, SCD was lower after ICD, but total mortality was comparable in the two groups.…”

“…This article reviews the relevant literature, aiming at reexamining the value of SAECG as a predictor of SCD, and suggests potential applications in various cardiac diseases. These topics gain importance in the context of primary SCD prevention, in view of the increasing demand for amending current risk‐stratification algorithms …”

“…These topics gain importance in the context of primary SCD prevention, in view of the increasing demand for amending current risk-stratification algorithms. 3 depolarization of myocardial regions of the left (LV) and right (RV) ventricles, which provide the substrate for reentrant ventricular tachycardia (VT) (Figure 1). Delayed local depolarization manifests as LPs, depicted as low-amplitude signals at the final portion of the QRS complex; these signals can be recorded in a lead obtained after mathematical combination of three separate orthogonal leads.…”