Noninvasive risk stratification for sudden death: signal-averaged electrocardiography, nonsustained ventricular tachycardia, heart rate variability, baroreflex sensitivity, and QRS duration.

摘要

Large clinical trials2'3 have shown tha prophylactic implantable cardioverter/defi brillator (ICD) implantation reduces mortality ir patients with severe left ventricular dysfunction However, even in this "high-risk" population, onh a minority of patients with ICDs ever receive life saving therapy. ' Although broad application of; strategy of relying on left ventricular dysfunctioi to select patients for prophylactic ICD implanta tion is marginally cost effective,4"8 implementa tion of this therapy in all patients meetinj eligibility criteria presents a significant economii burden, particularly outside the United States anc western Europe. Furthermore, current selectioi criteria for ICD implantation fail to address th< large number of patients with less severe lef ventricular dysfunction or normal ventricula: function who go on to experience sudden cardiai death—in fact, only a minority of sudden death: occur in patients with severe left ventricula: dysfunction at baseline.9