Prevention of Sudden Death in Patients with Dilated Cardiomyopathy
The prognosis of patients with congestive heart failure is poor. Depending on the severity of the disease, the annual mortality rate ranges between 10% and 50% [1–4]. The mode of death is circulatory failure or sudden cardiac death which accounts for approximately 50% of deaths [1,3–5]. There is a high prevalence of sudden death in patients with mild symptoms (50% sudden death rate) and in those with severe symptoms awaiting cardiac transplantation (25% sudden death rate). The proportion of sudden death however varies in different studies between 4% and 90%. This discrepancy may partly be explained by varying definitions, different patient populations and inclusion of non-classifiable deaths in the sudden death category. Non-ischemic (idiopathic) dilated cardiomyopathy (DCM) is the most common etiology. However, in some reports, no attempts have been made to differentiate non-ischemic from ischemic left ventricular dysfunction because in these studies only noninvasive diagnostic procedures were performed. This represents a major shortcoming of some large prospective studies in patients with heart failure as two completely different subgroups (ischemic vs. non-ischemic left ventricular dysfunction) are included. There are many clinical and hemodynamic parameters that might predict a poor prognosis due to impending circulatory failure. The identification of the patient at risk of sudden death however is difficult mainly because of different possible mechanisms and changes induced by the impaired left ventricular function.
KeywordsSudden Death Ventricular Tachycardia Ventricular Tachyarrhythmia Advanced Heart Failure Idiopathic Dilate Cardiomyopathy
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