The challenge of preventing arrhythmic
sudden death is one of the major issues of today's treatment of
heart failure. To pursue this aim, an accurate selection of candidates for
sudden death has to be routinely carried out, while a maximized and individualized
drug treatment has to be extensively administered in all high-risk selected patients. However, in clinical practice there is no agreement on the selection criteria of
sudden death risk, particularly in patients with advanced
heart failure. Furthermore, the real impact of each category of drugs in reducing the risk of
sudden death in
heart failure patients is still under debate. As far as non-pharmacological options are concerned,
implantable cardioverter-defibrillators (ICD) have been demonstrated to be the most effective
therapy in patients with prior
cardiac arrest due to
ventricular fibrillation or poorly tolerated
ventricular tachycardia. Low left ventricular ejection fraction, unsustained
ventricular tachycardia and inducibility at electrophysiological study also may identify high-risk patients requiring ICD implantation. However, such a stratification seems to be effective in ischemic more than in non-ischemic patients, while generally the primary prevention of
sudden death is still restricted to a minority of patients.
Biventricular pacing has been proven to be effective in optimizing left ventricular function in more than 50% of
left bundle branch block and advanced
heart failure patients, while further studies are needed to evaluate the real impact of
cardiac resynchronization therapy on hard endpoints, such as survival and long-term clinical outcome. Therefore, the selection criteria of "responders" to this novel non-pharmacological
therapy still have to be defined. There is convincing evidence in the literature that tailored
drug therapy can be highly effective in preventing
heart failure progression as well as in reducing total and sudden mortality. Nevertheless, prevention of
sudden death is still a debated point in
heart failure treatment. For this reason, we aimed to provide
heart failure specialists with updated reviews on this topic, such as those published in this issue of the Italian Heart Journal Supplement. Therefore, we are proud to present all the authors who contributed with the high quality of their articles to this editorial effort. Obviously, we have to thank the authors, but we also have to address the readers, thanking them in advance for their interest in such an initiative.