Death risk and dilated cardiomyopathy

The idiopatic dilated cardiomyopathy has high incidence in the general population. More prevalent in men, the sudden cardiac death or that due to deterioration of heart failure are an important social and economical problem. The good medical treatment help to improve the morbimortality and the implant of a cardiodefibrillator diminished the arrhythmic death. It is employed successfully for secondary prevention. There are not good indicators of risk to define the hazard in primary prevention. The antiarrhythmic drugs were evaluated in different trials (GESSICA, CHF-STAT, CAT, AMIOVIRT, SCD-HeFT) but efficacy for total prevention could not be demonstrated. Syncope as a clinical marker was important but not to determine the implant of a cardiodefibrillator. The risk of arrhythmic events was directed to the study of Holter monitoring and the prolongation and dispersion of QT interval. The autonomic dysfunction was analyzed by the heart rhythm variability and the baroreflex response. The presence of postpotentials, studied with the signal averaging ECG, evidence anatomic alterations. The analysis of microvolt T wave alternans, invasive electrophysiologic studies and nuclear magnetic resonance all of them have principally a negative predictor value. The ICD demonstrated the utility to prevent death but it is necessary to improve the method to a better selection of the patient to be implanted as primary prevention. The primary prevention has elevated costs that are difficult to assume in our Latin American economies.