Does the arrhythmic risk of patients with ischaemic cardiomyopathy really benefit from revascularisation therapy?

O ne of the most intractable health problems throughout the developed world continues to be sudden cardiac death (SCD). In the USA around 400,000 people per year die from SCD, making up about 63% of all deaths from cardiovascular causes. SCD usually develops on a substrate of ventricular tachycardia or fibrillation, and 80% of its victims suffer from coronary artery disease. Conversely, a history of myocardial infarction or heart failure implies an increased risk of SCD, usually because of ventricular tachyarrhythmias. More specifically, the risk of SCD increases by 4-6 times in patients with myocardial infarction, and by 6-9 times in those with heart failure.