New Markers Of Sudden Cardiac Death: Genetic Variables

All recently completed as well as ongoing sudden cardiac death (SCD) primary implantable cardiovertor defibrillator (ICD) prophylaxis trials have addressed patients with one or more conventional risk factors for SCD (Fig. 1). The electrophysiologic surrogates for SCD, including measures of myocardial conduction disorders, dispersion of repolarisation, and autonomic imbalance, are based on sound scientific evidence. Although it is acknowledged that the positive predictive power of a risk stratifier in a clinical trial is closely related to the duration of follow-up, the majority of conventional risk stratifiers of SCD have a relatively low positive predictive value, which would preclude their wide application as guidelines for ICD implantation in patients known to be at risk for SCD. This is not to mention the impracticality of their use for risk stratification in the general asymptomatic public. This has prompted the search for new approaches for risk stratification and management of SCD based on recent insights gained from advances in molecular biology and genetics.