About this Book

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.