Georg Schmidt

Federico Lombardi

Marek Malik

Richard Leonard Verrier

Effective identification of patients at increased risk of malignant cardiac arrhythmia presently represents a clinically important unmet need. Existing guidelines for the selection of candidates for the prophylactic implantation of cardioverters-defibrillators (ICD) are based solely on the reduction of ventricular haemodynamic performance. Although this guidance is based on statistical results of previously conducted randomized clinical trials, available experience shows that it does not serve clinical needs efficiently. The majority of patients who are implanted with ICDs for prophylactic reasons never utilize the device during its technical longevity whilst, at the same time, many patients who succumb to sudden cardiac death do not have ventricular haemodynamic performance particularly compromised. Recent results also showed that the previous statistical findings of ICD efficacy are not fully reproducible in patients with non-ischemic heart disease and that the reduction of sudden cardiac death after myocardial infarction by external automatic defibrillation vests is lower than expected. Advances in cardiac electrophysiology are needed for better understanding of the mechanisms that are the basis of different arrhythmic abnormalities. Increased understanding of these mechanisms will allow them to be more effectively classified so that optimum therapeutic options can be offered. Likewise, better understanding of the underlying electrophysiology processes is needed so that novel and more focused randomized clinical trials can be designed. Compared to invasive electrophysiological studies, noninvasive cardiac electrophysiology offers the possibility of screening larger number of patients as well as healthy subjects investigated under different provocations and conditions. To advance the field, broad spectrum of studies is needed together with meta-analyses and reviews facilitating research interactions.

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