Profiling risk from arrhythmic or hemodynamic death

Congestive heart failure is increasing in prevalence and, despite recent ad vances in therapy, mortality remains high. Sudden cardiac death (SCD) repre sents a significant percentage of overall mortality, accounting for almost 1 in 2 deaths in patients with congestive heart failure. In patients with a symptomatic left ventricular dysfunction or mild degrees of functional impa irement, overall annual mortality is low, although a significant portion of the deaths ore sudden; on the other hand, in advanced heart failure annual mortality increases, but SCD contributes to it to a lesser degree. The mec hanisms of SCD in heart failure are multiple, including ventricular tachyca rdia/ventricular fibrillation, bradyarrhythmias, electromechanical dissocia tion, acute coronary events, and thromboembolic events. Only a minority of patients with advanced heart failure or on the waiting list. for heart tran splant experience SCD as a consequence of ventricular tachycardia (VT) or v entricular fibrillation (VF). The availability of effective therapies to pr event sudden arrhythmic death, such as that provided by automatic implantab le cardioverter defibrillators, may help to reduce the burden of SCD in con gestive heart failure, but major efforts will be needed to identify the can didates who may benefit from this approach, (C) 2000 by Excerpta Medica, In c.