A paradigm change in sudden cardiac death risk prediction: 'static' goes out, 'dynamic' comes in

Graphical Abstract Risk stratification for sudden cardiac death (SCD) is evolving from being based on static (single) to dynamic (multiple over time) measurements of parameters related to ventricular repolarization. They include, in an anticlockwise sequence, T wave alternans (TWA), T wave heterogeneity (TWH), periodic repolarization dynamics (PRD), and electrical risk score (ERS), a multiparametric score incorporating six variables, including Tpeak-Tend (TpTe) and corrected QT interval (QTc): changes over time of these two parameters improve SCD prediction. On the far right, the figure summarizes the first evidence of this dating back to 1978: measurement of QTc repeated over time for several years indicates that a consistent QTc prolongation more than doubles the risk for SCD (figure from ref. 11 with permission).