Key result
Two-step stratification using non-invasive factors to guide EPS emerges as an efficient SCD risk paradigm.
Why the study?
ICD guidelines are still dominated by LVEF<30% despite ischemic, non-ischemic, and hypertrophic cardiomyopathies accounting for over 80% of sudden cardiac death victims.
A two-step risk stratification approach using non-invasive risk factors to guide electrophysiological studies is highlighted as an efficient paradigm for predicting sudden cardiac death across multiple cardiomyopathies.
Hypothesis-generating for NIRF-guided EPS in cardiomyopathy; prospective trials needed before practice change.
Arrhythmic sudden cardiac death (SCD) has an annual prevalence of 1 per 1000 while 75% of the victims suffer from ischemic and 10% from non-ischemic or hypertrophic cardiomyopathy. Altogether, these three entities account for more than 80% of the total SCD victims. Guidelines for implantable cardiac defibrillators are still dominated by LVEF<30% from the MADIT II study. In terms of arrhythmic risk stratification, the PRESERVE-EF study restored in clinical practice the two-step arrhythmic risk stratification approach based on Electrocardiographic non-invasive risk factors (NIRFs) guiding to electrophysiological study. In our times with the multiple cardiac imaging methods and artificial intelligence applications availability, this two-step approach based on integrated arrhythmia mechanisms detection, emerges as an efficient SCD risk stratification paradigm for these three entities but also for the patients with congenital heart disease.
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Αρσένος et al. (2023) conducted a review in Sudden Cardiac Death in Ischemic, Non-ischemic, and Hypertrophic Cardiomyopathy. Two-step arrhythmic risk stratification approach was evaluated. A two-step risk stratification approach using non-invasive risk factors to guide electrophysiological study emerges as an efficient sudden cardiac death risk stratification paradigm.
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