title: Sudden death prophylaxis in heart failure.
abstract: Sudden cardiac death (SCD) is the leading cause of mortality in heart failure (HF). Today the implantable cardioverter-defibrillator (ICD) has become a commonplace therapy around the world for patients with both ischemic and non-ischemic cardiomyopathy and an ejection fraction (EF) < or = 35%. However, EF alone does not discriminate between the modes of death from HF (sudden arrhythmic death vs. non-sudden death). Other risk statifiers, such as electrophysiologic study and microvolt T-wave alternans testing, should therefore be used in the appropriate settings to minimize the number of unnecessary device implants. In addition, left ventricular mechanical dyssynchrony has now become recognized as an additional major marker of cardiac mortality. Its assessment should entail echocardiography rather than measurement of the QRS duration. This will allow us to better integrate the ability of cardiac resynchronization therapy (CRT) in enhancing cardiac function with the ability of an ICD in preventing SCD. This review aims to: 1) give a synthesis of the published evidence regarding the value of implantable ICDs and CRT in the primary prophylaxis of SCD in HF; 2) discuss controversial clinical issues in this area; and 3) recommend practical device-based management strategies.
authors.affiliation: The Department of Internal Medicine, Division of Cardiology, The University of Texas Medical Branch, Galveston, Texas 77555-0553, United States. sarosani@utmb.edu
authors.forename: Salvatore
authors.initials: S
authors.lastname: Rosanio
authors.forename: Ernst R
authors.initials: ER
authors.lastname: Schwarz
authors.forename: Antonio
authors.initials: A
authors.lastname: Vitarelli
authors.forename: Ignatius Gerardo E
authors.initials: IG
authors.lastname: Zarraga
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kunapuli
authors.forename: David L
authors.initials: DL
authors.lastname: Ware
authors.forename: Yochai
authors.initials: Y
authors.lastname: Birnbaum
authors.forename: Enrique
authors.initials: E
authors.lastname: Tuero
authors.forename: Barry F
authors.initials: BF
authors.lastname: Uretsky
mesh_terms: D016757:Death, Sudden, Cardiac / Q000209:etiology* / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D010138:Pacemaker, Artificial; D013318:Stroke Volume / Q000502:physiology