title: An electrophysiologist perspective on risk stratification in heart failure: can better understanding of the condition of the cardiac sympathetic nervous system help?
abstract: Heart failure is often complicated by arrhythmias that can adversely affect the quality of life and increase the risk for sudden cardiac death. Current risk stratification strategies for sudden cardiac death in the heart failure patient are not ideal, with much potential for further refinement. Overactivation of the sympathetic nervous system has been shown to be associated with worsening heart failure as well as arrhythmic events. Recent advances in our understanding of the autonomic nervous system and new methods for quantification of the pathologic activation of the sympathetic nerves have triggered increasing interest in this field. This viewpoint focuses on the need for and challenges of risk stratification of sudden death in the heart failure patient and discusses the potential value of measuring sympathetic nervous system activity to better stratify risk and to select patients with heart failure for implantable cardioverter defibrillator therapy.
authors.affiliation: Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and Arrhythmia Clinic, Lund University, Skåne University Hospital, Lund, Sweden.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Borgquist
authors.affiliation: Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and jsingh@mgh.harvard.edu.
authors.forename: Jagmeet P
authors.initials: JP
authors.lastname: Singh
mesh_terms: D019797:3-Iodobenzylguanidine; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging; D001341:Autonomic Nervous System / Q000000981:diagnostic imaging; D016757:Death, Sudden, Cardiac; D017147:Defibrillators, Implantable; D004594:Electrophysiology / Q000379:methods*; D006321:Heart / Q000294:innervation; D006333:Heart Failure / Q000000981:diagnostic imaging*; D006801:Humans; D011788:Quality of Life; D018570:Risk Assessment; D013564:Sympathetic Nervous System / Q000000981:diagnostic imaging* / Q000473:pathology; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019797:3-Iodobenzylguanidine
keywords: autonomic defibrillator; cardiology (clinical); sudden death