T-wave alternans: predicting the unpredictable?

Sudden cardiac death (SCD) due to ventricular arrhythmias hasa high morbidity and mortality. It is no wonder that cardiologists,rather than patching up survivors, are dedicated to findingpredictors of cardiac electrical instability to prevent SCD.The implantable cardiac defibrillator (ICD) has evolved as theultimate strategy for sudden arrhythmic death. In secondaryprevention, individuals are recognized by an aborted arrhythmicevent. By stratifying according to left ventricular ejectionfraction (LVEF) below 35%, SCD may also be prevented by an ICDin individuals without any prior arrhythmic event.¹ However,the relative SCD risk based