title: Risk stratification for sudden cardiac death: current status and challenges for the future.
abstract: Sudden cardiac death (SCD) remains a daunting problem. It is a major public health issue for several reasons: from its prevalence (20% of total mortality in the industrialized world) to the devastating psycho-social impact on society and on the families of victims often still in their prime, and it represents a challenge for medicine, and especially for cardiology. This text summarizes the discussions and opinions of a group of investigators with a long-standing interest in this field. We addressed the occurrence of SCD in individuals apparently healthy, in patients with heart disease and mild or severe cardiac dysfunction, and in those with genetically based arrhythmic diseases. Recognizing the need for more accurate registries of the global and regional distribution of SCD in these different categories, we focused on the assessment of risk for SCD in these four groups, looking at the significance of alterations in cardiac function, of signs of electrical instability identified by ECG abnormalities or by autonomic tests, and of the progressive impact of genetic screening. Special attention was given to the identification of areas of research more or less likely to provide useful information, and thereby more or less suitable for the investment of time and of research funds.
authors.affiliation: Cardiovascular Research Center, Maastricht, The Netherlands.
authors.forename: Hein J J
authors.initials: HJ
authors.lastname: Wellens
authors.affiliation: IRCCS Istituto Auxologico Italiano, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy peter.schwartz@unipv.it.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Schwartz
authors.affiliation: Medtronic Bakken Research Center, Maastricht, The Netherlands.
authors.forename: Fred W
authors.initials: FW
authors.lastname: Lindemans
authors.affiliation: Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Alfred E
authors.initials: AE
authors.lastname: Buxton
authors.affiliation: Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Goldberger
authors.affiliation: Division of Clinical Electrophysiology, Department of Cardiology, J. W. Goethe University, Frankfurt, Germany.
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Hohnloser
authors.affiliation: Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland.
authors.forename: Heikki V
authors.initials: HV
authors.lastname: Huikuri
authors.affiliation: Department of Medicine I, University Hospital, Ludwig-Maximilians-University, Münich, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Münich Heart Alliance, Münich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kääb
authors.affiliation: Department of Cardiology, Fondazione 'Salvatore Maugeri', IRCCS, Istituto Scientifico di Montescano, Montescano, Pavia, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: La Rovere
authors.affiliation: St Paul's Cardiac Electrophysiology, University of London and Imperial College, London, UK.
authors.forename: Marek
authors.initials: M
authors.lastname: Malik
authors.affiliation: Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Myerburg
authors.affiliation: Thoraxcentrum, Erasmus MC, Cardiology, Rotterdam, The Netherlands.
authors.forename: Maarten L
authors.initials: ML
authors.lastname: Simoons
authors.affiliation: University of Gothenburg, Gothenburg, Sweden.
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Tijssen
authors.affiliation: University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.affiliation: Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands Princess Al Jawhara Albrahim Centre of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Arthur A
authors.initials: AA
authors.lastname: Wilde
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D001342:Autonomic Nervous System Diseases / Q000150:complications / Q000175:diagnosis; D015415:Biomarkers / Q000378:metabolism; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D042241:Early Diagnosis; D004562:Electrocardiography; D005260:Female; D005544:Forecasting; D005820:Genetic Testing; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods / Q000639:trends; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D015415:Biomarkers
keywords: Autonomic nervous system; Cardiac function; Electrical instability; Genetics; Risk stratification; Sudden cardiac death