**Author details**

Ann M. Anderson1 and M. Obadah Al Chekakie2

1 Cheyenne Regional Medical Center, Cheyenne, WY, USA

2 University of Colorado, Cheyenne Regional Medical Center, Cheyenne, Wyoming,, USA

#### **References**

[1] Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular ar‐ rhythmias and the prevention of sudden cardiac death: a report of the American Col‐ lege of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Pre‐ vention of Sudden Cardiac Death). J Am Coll Cardiol. 2006;48(5):e247-346.

[2] Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352(3):225-237.

**5. Conclusions and future directions**

and might remain so for the near future.

and M. Obadah Al Chekakie2

2 University of Colorado, Cheyenne Regional Medical Center, Cheyenne, Wyoming,, USA

[1] Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular ar‐ rhythmias and the prevention of sudden cardiac death: a report of the American Col‐ lege of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Pre‐

vention of Sudden Cardiac Death). J Am Coll Cardiol. 2006;48(5):e247-346.

1 Cheyenne Regional Medical Center, Cheyenne, WY, USA

**Author details**

Ann M. Anderson1

**References**

options.

222 Cardiomyopathies

Sudden cardiac death remains a challenge for health providers and policy makers. Whether more stringent guidelines for prevention and screening will be applied is balanced by the enormous costs. In order to identify the groups at risk for sudden cardiac death there must first be a standardization of the definition. The worldly variation in this definition of sudden cardiac death of 1 hour from onset of symptoms to 24 hours, not only effects epidemiological data but also alters clinical trial outcomes when evaluating the effectiveness of treatment

Currently, antiarrhythmic medications have failed to show any benefit of sudden cardiac death prevention, while traditional heart failure medications have been shown to decrease total mortality, sudden cardiac death and defibrillator shocks. They are only used in a small subset of patients that present in sudden cardiac death, since most of the patients who have sudden cardiac death have it as a first presentation and do not have congestive heart failure or history of coronary artery disease. This poses a diagnostic and therapeutic challenge for the clinician. Taking statins as an example, most of the primary prevention algorithms used to start lipid lowering agents usually leads to delayed intervention, especially since coronary atheroscle‐ rosis has been shown to start at a young age. The cost of starting this treatment is also enormous, especially if it is started on a global scale at a young age and it is not without side effects. Genetic studies to identify patients at risk for coronary atherosclerosis are still under devel‐ opment. Preventing sudden cardiac death is definitely a challenge for the 21st century clinician


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**Chapter 11**

**Risk Stratification of Sudden Cardiac Death by**

**Patients with Chronic Heart Failure and Dilated**

Yoshikazu Yazaki, Toshimasa Seki, Atsushi Izawa,

Additional information is available at the end of the chapter

**Cardiomyopathy**

Minoru Hongo and Uichi Ikeda

http://dx.doi.org/10.5772/55615

**1. Introduction**

den death without SVT.

cardiac death [6, 7].

and a history of ventricular fibrillation.

**Evaluating Myocardial Sympathetic Nerve Activity Using**

A Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) has proven the efficacy of prophylactic implantable cardioverter defibrillator (ICD) use for chronic heart failure pa‐ tients without sustained ventricular tachycardia (SVT) and a history of ventricular fibril‐ lation, not restricted in those with myocardial infarction [1]. Since ICD is an expensive device, risk stratification is required to identify heart failure patients at high risk for sud‐

Iodine-123 Metaiodobenzylguanidine (123I-MIBG) is an analogue that metabolizes in a manner similar to that of norepinephrine (NE) [2]. 123I-MIBG is used to assess myocardial sympathetic nervous activity, and a decrease in myocardial 123I-MIBG uptake and an increase in spillover have been observed in patients with heart failure and are related to disease severity [3-5]. An increase in sympathetic tone is associated with ventricular tachyarrhythmia and sudden

Therefore, the purpose of this study was to test our hypothesis that 123I-MIBG scintigraphy may be useful in the prediction of future sudden death in heart failure patients without SVT

and reproduction in any medium, provided the original work is properly cited.

© 2013 Yazaki et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

distribution, and reproduction in any medium, provided the original work is properly cited.

**Iodine-123 Metaiodobenzylguanidine Scintigraphy in**

**Risk Stratification of Sudden Cardiac Death by Evaluating Myocardial Sympathetic Nerve Activity Using Iodine-123 Metaiodobenzylguanidine Scintigraphy in Patients with Chronic Heart Failure and Dilated Cardiomyopathy**

Yoshikazu Yazaki, Toshimasa Seki, Atsushi Izawa, Minoru Hongo and Uichi Ikeda

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/55615

**1. Introduction**

A Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) has proven the efficacy of prophylactic implantable cardioverter defibrillator (ICD) use for chronic heart failure pa‐ tients without sustained ventricular tachycardia (SVT) and a history of ventricular fibril‐ lation, not restricted in those with myocardial infarction [1]. Since ICD is an expensive device, risk stratification is required to identify heart failure patients at high risk for sud‐ den death without SVT.

Iodine-123 Metaiodobenzylguanidine (123I-MIBG) is an analogue that metabolizes in a manner similar to that of norepinephrine (NE) [2]. 123I-MIBG is used to assess myocardial sympathetic nervous activity, and a decrease in myocardial 123I-MIBG uptake and an increase in spillover have been observed in patients with heart failure and are related to disease severity [3-5]. An increase in sympathetic tone is associated with ventricular tachyarrhythmia and sudden cardiac death [6, 7].

Therefore, the purpose of this study was to test our hypothesis that 123I-MIBG scintigraphy may be useful in the prediction of future sudden death in heart failure patients without SVT and a history of ventricular fibrillation.

© 2013 Yazaki et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
