Implantable cardioverter-defibrillator therapy and the total burden of sudden cardiac death

This editorial refers to ’Ventricular arrhythmia in coronary artery disease: limits of a risk stratification strategy based on the ejection fraction alone and impact of infarct localization’ by P. Pascale et al., on page 1639. Sudden cardiac death (SCD) affects 400 000 individuals annually in Europe, causing more deaths than AIDS, lung and breast cancer, and stroke together. More than 50% of all cardiovascular deaths are sudden and unexpected, accounting for 1–2 deaths/1000 adults over the age of 35 years. Despite considerable advances in the field, cardiac arrhythmias and SCD remain major contributors to morbidity and mortality in the Western world, representing a tremendous burden to families, community, and health care. Within the populations suffering from SCD are high-risk subgroups, largely those with left ventricular ejection fractions (LVEF) ,35% after myocardial infarction. 1 A large majority of