title: Arrhythmic risk stratification in heart failure: Time for the next step?
abstract: BACKGROUND
  Primary prevention of sudden cardiac death by means of implantable cardioverter-defibrillators constitutes the holy grail of arrhythmology. However, current risk stratification algorithms lead to suboptimal outcomes, by both allocating ICDs to patients not deriving any meaningful survival benefit and withholding them from those erroneously considered as low-risk for arrhythmic mortality.
  
  
  METHODS
  In the present review article we will attempt to present shortcomings of contemporary guidelines regarding sudden death prevention in ischemic and dilated cardiomyopathy patients and present available data suggesting encouraging results following implementation of multifactorial approaches, by using multiple modalities, both noninvasive and invasive. Invasive electrophysiological testing, namely programmed ventricular stimulation, will be discussed in greater length to highlight both its potential usefulness and currently ongoing multicenter studies aiming to provide evidence necessary to make the next step in sudden death risk stratification.
  
  
  RESULTS
  Promising findings have been reported by multiple study groups regarding novel strategies for both negative selection of low and positive selection of relatively preserved ejection fraction patients as candidates for ICD implantation.
  
  
  CONCLUSIONS
  The era of ejection fraction as the sole risk stratifier for arrhythmic risk in heart failure appears to be drawing to an end, especially if current underway large studies validate previous findings.
authors.affiliation: Electrophysiology Laboratory, First Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Konstantinos A
authors.initials: KA
authors.lastname: Gatzoulis
authors.affiliation: Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece.
authors.forename: Antonios
authors.initials: A
authors.lastname: Sideris
authors.affiliation: Department of Cardiology, University General Hospital of Heraklion, Heraklion, Greece.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Kanoupakis
authors.affiliation: State Department of Cardiology, "Hippokration" General Hospital, Athens, Greece.
authors.forename: Skevos
authors.initials: S
authors.lastname: Sideris
authors.affiliation: Department of Cardiology, "Konstantopouleio" General Hospital, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Nikolaou
authors.affiliation: Electrophysiology Laboratory, First Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Christos-Konstantinos
authors.identifier: http://orcid.org/0000-0002-6628-0303
authors.initials: CK
authors.lastname: Antoniou
authors.affiliation: Department of Cardiology, University General Hospital of Ioannina, Ioannina, Greece.
authors.forename: Theofilos M
authors.initials: TM
authors.lastname: Kolettis
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications* / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D004562:Electrocardiography / Q000379:methods*; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D018570:Risk Assessment; D012307:Risk Factors
keywords: multifactorial approach; primary prevention; programmed ventricular stimulation; risk stratification; sudden cardiac death