Preventing arrhythmic sudden death is one of the major issues in today's treatment of heart failure. To do so, figuring out who is at high risk is necessary. The rate of sudden death is much higher in ischemic dilated cardiomyopathy than it is in non-ischemic dilated cardiomyopathy. Also, fast-heart-rate arrhythmic sudden death is common in Classes 1 and 2, but less common in Classes 3 and 4. Slow-heart-rate arrhythmias, electro-mechanical error and blood clot/blockage make up the other half of sudden deaths in Class 3 and 4 patients.
	Identifying arrhythmic risk level in non-ischemic dilated cardiomyopathy is questionable from any point of view, considering the poor predictive power of tests. However, some subgroups of high-risk patients should be selected, such as patients waiting for heart transplant or those with a severe disease but without extreme ventricular dysfunction. In these patients, the prognosis in terms of pump failure events is better and life expectancy is longer if the risk of arrhythmia is properly assessed and sudden death is prevented.
	So the ICD implant may be effective to reduce arrhythmic death in patients with severe disease and to minimize the fast-heart-rate arrhythmic risk in those with less severe disease. Further studies will be developed to identify ideal candidates for ICD implants.

Title: The stratification and prevention of the arrhythmia risk in nonischemic dilated cardiomyopathy
Authors: Ansalone G; Giannantoni P; Santini M - Dipartimento delle Malattie del Cuore, Azienda Ospedaliera San Filippo Neri, Roma
From: G Ital Cardiol 1998 Nov;28(11):1288-302
PMID: 9866807 UI: 99084039