Letters To The Editor
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jan 26, 2016; 8(1): 112-113
Published online Jan 26, 2016. doi: 10.4330/wjc.v8.i1.112
Electrophysiologic testing guided risk stratification approach for sudden cardiac death beyond the left ventricular ejection fraction
Konstantinos A Gatzoulis, Dimitris Tsiachris, Petros Arsenos, Dimitris Tousoulis
Konstantinos A Gatzoulis, Dimitris Tsiachris, Petros Arsenos, Dimitris Tousoulis, First Cardiology Division, Hippokration Hospital, University of Athens, 11527 Athens, Greece
Author contributions: Gatzoulis KA and Arsenos P wrote this letter; Tsiachris D and Tousoulis D revised the letter.
Conflict-of-interest statement: Dr. Gatzoulis KA received a supporting grand for PRESERVE EF study equipment by Medtronic and GE; Dr. Tsiachris D received grand from Medtronic; Dr. Arsenos P received research equipment support by Sorin; Dr. Tousoulis D has no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Konstantinos A Gatzoulis, MD, Associate Professor of Cardiology, Director of EP Lab, First Cardiology Division, Hippokration Hospital, University of Athens, PO Box 175, 11527 Athens, Greece. kgatzoul@med.uoa.gr
Telephone: +30-210-3644570
Received: July 17, 2015
Peer-review started: July 22, 2015
First decision: September 11, 2015
Revised: September 29, 2015
Accepted: November 3, 2015
Article in press: November 3, 2015
Published online: January 26, 2016
Processing time: 188 Days and 11.8 Hours
Abstract

Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators (ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death.

Keywords: Electrophysiologic study; Risk stratification; Sudden cardiac death; Myocardial infarction; Preserved ejection fraction

Core tip: There is a growing need for more effective risk stratification approach in order to detect those post myocardial infarction and dilated cardiomyopathy patients at high risk for sudden cardiac death (SCD) at early or even asymptomatic stage of heart failure with relatively well preserved left ventricular ejection fraction (LVEF). Although in an individual basis the SCD risk is lower among the patient population compared to the one observed among to those with a severely impaired LVEF, epidemiologically there is a large such patient pool at risk in the community. Based on preliminary evidence these patients could be effectively and timely identified by applying a combined electrophysiologic guided approach using non-invasive electrocardiogram-related markers of risk leading to programmed ventricular stimulation testing. Using this approach, we could select those with inducible ventricular tachyarrhythmias as suitable candidates for implantable defibrillator therapy.