Non-invasive risk stratification and prediction of outcome in patients with arrhythmic disorders and risk for sudden death

Background:

Risk stratification in patients predisposed to cardiac arrhythmias and at risk for sudden death is an unmet clinical challenge. Electrocardiography offers a non-invasive diagnostic approach, which is applied routinely in clinical practice, however the use of information contained in the conventional ECG is still suboptimal. Computer-based ECG processing allows identification of subtle abnormalities in the atrial and ventricular components of ECG, which can be used for prediction of arrhythmias such as atrial fibrillation (AF) and ventricular arrhythmias in patients with inherited cardiomyopathies and in the settings of acute ischemia and myocardial infarction.

ECG-based risk stratification remains unresolved for the large and growing group of phenotype-negative individuals carrying familial mutations associated with risk for life-threatening arrhythmias, such as arrhythmogenic right ventricular cardiomyopathy (ARVC). Objectives:

- To assess conventional and experimental ECG markers of predisposition to AF in a population-based setting and in patients with ischemic heart disease - To improve risk stratification in patients discharged after acute myocardial infarction

- To evaluate contribution of signal-averaged ECG indices to diagnosis and assessment of arrhythmic risk in patients with ARVC Research plan:

The research program is focused on AF, acute ischemia and inherited genetic cardiomyopathies. Non-invasive risk stratification and outcome prediction are important for all of these conditions are central for this application. Research program includes: - register-based studies on patients with myocardial infarction

- ECG substudy in the framework of the SCAPIS research network

- prospective observational study in the framawork of the Nordic Register of Arrhythmigenic Right Ventricular Cardiomyopathy - register-based nation-based study of ventricular fibrillation during acute ischemia (VALIDATE-VF substudy) Clinical significance:

Risk stratification and prediction of outcome are essential components of patient management. When used appropriately, risk stratification tools allow improved survival, optimization of the resource use leading to better intervention results and improvement of quality of life. Non-invasive diagnostic approach, which is the focus of current application is aimed to minimize implementation costs by maximizing extraction of information from routinely applied diagnostic techniques.