Treatment of ventricular dysrhythmias and sudden cardiac death: a guideline-based approach for patients with chronic left ventricular dysfunction.

With the rise in the use of device therapy implants, we are better identifying appropriate chronic heart failure patients for primary implantable defibrillator therapy who are at risk of ventricular arrhythmia. As our knowledge expands, however, controversial issues emerge. Guidelines have been endorsed by the major international societies, such as the American College of Cardiology (ACC), the American Heart Association (AHA), and the European Society of Cardiology. In view of certain variances in recommendations and new data, a recent joint guideline statement has been issued from these 3 societies regarding management of ventricular arrhythmia and preventing sudden cardiac death in patients with left ventricular dysfunction and heart failure. In this review, the recent joint statement is compared with those from the Heart Failure Society of America (Heart Failure Practice Guidelines 2006) and ACC/AHA (Heart Failure Guidelines 2005), with a special emphasis on new expanded criteria for primary prevention in both ischemic and nonischemic heart disease. In addition, the authors review current guidelines for electrophysiology testing in chronic left ventricular dysfunction and the emerging role of microvolt T-wave alternans as a means of risk stratification.