Right Ventricular Dysfunction: An Overlooked Predictor of Sudden Cardiac Death and Arrhythmic Events — A Meta-Analysis

Abstract Background and Aim Right ventricular (RV) dysfunction has emerged as a potential predictor of adverse cardiac outcomes, including sudden cardiac death (SCD) and severe ventricular arrhythmias (VA). To clarify the role of RV dysfunction in arrhythmic risk assessment, we conducted a systematic review and meta-analysis to evaluate its prognostic value for SCD and VA. Methods A systematic search of PubMed, Embase, and Web of Science was conducted from inception to February 2025. The primary endpoint was a composite of SCD or severe VA, including ventricular tachycardia, ventricular fibrillation, or appropriate implantable cardioverter-defibrillator therapy. RV dysfunction was defined as impaired RV fractional area change, RV ejection fraction, or RV strain. A random-effects model was used to calculate pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). Results Of 1,296 identified articles, seven studies comprising 1,475 patients met inclusion criteria. RV dysfunction was present in 541 patients. The mean follow-up duration was 2.9 years. RV dysfunction was significantly associated with an increased risk of SCD and VA (RR: 3.73; 95% CI: 2.43–5.72; p < 0.01). Secondary analysis showed that patients who experienced SCD or VA had significantly lower RVFAC compared to those without events (MD: −5.67; 95% CI: −8.73 to −2.60; p < 0.01), whereas LVEF did not differ significantly between groups (MD: −0.59; 95% CI: −4.10 to 2.92; p = 0.74). Conclusions RV dysfunction is associated with a increased risk of SCD and VA, indicating that RV parameters may hold prognostic value in arrhythmic risk stratification.