Sudden cardiac death (SCD) remains a major public health
problem in developed countries. Nonetheless, the last two decades
have witnessed many advances in the epidemiology
of SCD, its prediction and prevention.
We have learned that approximately half of these events occur
in individuals without a previously diagnosed heart disease.
The proportion of the presenting arrhythmia in patients
with cardiac arrest has somewhat changed from ventricular
fibrillation towards pulseless electrical activity and asystole.
These observations, if further confirmed, may challenge previous
strategies of risk stratification and the management of
survivors of cardiac arrest.
Despite efforts to identify patients with clinical, anatomic, autonomic,
electrical, and/or transient risk factors, the predictive
accuracy of relevant diagnostic tests remains often inconclusive.
Further progress in this field can be expected by imaging
studies that are playing an increasing role in identification of
high-risk patients. There have been major advances in the
understanding of the role of genetics and we have clearly
entered in an era in which knowledge of the genotype will
contribute to a better individualization of the management
of patients at risk for life-threatening arrhythmias of genetic