Sudden death in dilated cardiomyopathy

AbstractThe purpose of this review is to examine the potential contribution of arrhythmia to the occurrence of sudden death in dilated cardiomyopathy (DCM) and to discuss current treatment options. We performed a search of the MEDLINE database from 1985 to the present and the reference citations of selected articles pertaining to the prognostic significance, management, and pathophysiology of arrhythmias in DCM. A large proportion of patients with DCM die suddenly, most secondary to ventricular arrhythmia and a smaller proportion due to bradyarrhythmia. The presence and severity of ventricular ectopy may predict risk for sudden death, but the role of electrophysiologic study and signal‐averaged electrocardiography in further risk stratifying patients remains uncertain. Abnormalities of the autonomic nervous system and renin‐angiotensin‐aldosterone axis appear to promote the occurrence of ventricular arrhythmias. Angiotensin‐converting enzyme inhibitors improve overall mortality in congestive heart failure, and the use of direct angiotensin‐receptor antagonists is currently being studied. In addition, beta‐receptor antagonists appear to improve morbidity and may prove to improve mor