Biosignal-guided personalized therapy

Abstract

Sudden cardiac death (SCD) is the leading single cause of death in the industrialized world. Current guidelines recommend a prophylactic implantation of an implantable cardioverter-defibrillator (ICD) in patients with reduced left-ventricular ejection fraction (LVEF ≤ 35%). However, most deaths after myocardial infarction (MI) occur in patients with normal or moderately reduced LVEF (>35%). There is a large body of evidence that cardiac autonomic dysfunction after MI is linked to increased susceptibility to malignant arrhythmias. Deceleration capacity of heart rate (DC) and periodic repolarization dynamics (PRD) are novel ECG-based risk markers, which capture different facets of cardiac autonomic dysfunction. Both parameters are strong and independent predictors of mortality and SCD after MI. Previous studies indicated that combined assessment of DC and PRD allows identification of a new high-risk group among post-infarction patients that is not addressed by current guidelines, thus opening new perspectives for biosignal-guided personalized therapies.

Keywords

• sudden death
• risk stratification
• autonomic nervous system