Arrhythmic Risk Stratification in Cardiac Health

Arrhythmic risk stratification seeks to identify individuals at elevated risk of life‐threatening cardiac rhythm disturbances, most notably sudden cardiac death. It encompasses a spectrum of methodologies ranging from simple surface electrocardiographic markers to advanced computational models that integrate clinical, imaging and electrophysiological data. Central objectives are to refine the selection of patients who will benefit from implantable cardioverter‐defibrillators or other targeted interventions, to reduce unnecessary device implantation and to optimise outcomes. Advances in non‐invasive diagnostics—such as high‐resolution signal averaging, ambulatory monitoring and novel biomarkers—have sharpened predictive accuracy. Concurrently, machine‐learning approaches and mechanistic simulations are beginning to capture subtle interplays between autonomic tone, myocardial substrate and electrophysiological triggers. The global burden of arrhythmic sudden death, particularly in ischaemic and non‐ischaemic cardiomyopathies, spurs ongoing efforts to translate these innovations into scalable screening and personalised management pathways.

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Arrhythmic Risk Stratification in Cardiac Health publication trend

The graph below shows the total number of articles in arrhythmic risk stratification in cardiac health across all publications each year (not limited to Nature Index journals).

Technical terms

T-wave alternans (TWA): Microvolt-level beat-to-beat variations in T-wave amplitude reflecting repolarisation instability.

Heart rate turbulence (HRT): Baroreflex‐mediated heart rate fluctuations following a ventricular premature complex.

Late potentials (LP): Low-amplitude, high-frequency signals at the terminal QRS, detected by signal-averaged ECG and indicating slowed conduction.

Non-sustained ventricular tachycardia (NSVT): Runs of three or more consecutive ventricular beats at a rate >100 bpm lasting less than 30 seconds.

Programmed ventricular stimulation (PVS): Invasive electrophysiological testing in which timed electrical impulses are applied to provoke arrhythmias.

Left ventricular ejection fraction (LVEF): Percentage of blood ejected from the left ventricle during systole, used to classify heart failure severity.

References

1. Sudden cardiac death and pump failure death prediction in chronic heart failure by combining ECG and clinical markers in an integrated risk model. PLOS ONE (2017).
2. Combined evaluation of ambulatory‐based late potentials and nonsustained ventricular tachycardia to predict arrhythmic events in patients with previous myocardial infarction: A Japanese noninvasive electrocardiographic risk stratification of sudden cardiac death (JANIES) substudy. Annals of Noninvasive Electrocardiology (2020).
3. Arrhythmic risk stratification in heart failure mid‐range ejection fraction patients with a non‐invasive guiding to programmed ventricular stimulation two‐step approach. Journal of Arrhythmia (2020).