Noninvasive risk stratification in inherited arrhythmias

Abstract

Electrocardiographic risk stratification of patients with inherited arrhythmopathies, such as the long-QT syndrome and Brugada syndrome, is unsatisfactory at present. Changes in ventricular depolarization and repolarization as well as autonomic triggers play a pivotal role in the genesis of malignant tachyarrhythmias in these disorders. However, only sparse data are available regarding the usefulness of autonomic or repolarization markers for identification of patients at potential risk of sudden arrhythmogenic death. Whereas the duration of the QT interval as well as analysis of dispersion of repolarization have been used to risk stratify LQTS patients, analysis of ventricular late potentials seems to be promising in patients with Brugada syndrome. With respect to autonomic risk markers, there are currently not enough data to generally justify their use in either of the two entities. More research is necessary to improve risk stratification in phenotypically "silent" gene carriers.