Right ventricular dysfunction: an overlooked predictor of sudden cardiac death and arrhythmic events—a meta-analysis

BACKGROUND: Right ventricular (RV) dysfunction has emerged as a potential predictor of adverse cardiac outcomes, including sudden cardiac death (SCD) and severe ventricular arrhythmias (VAs). To clarify the role of RV dysfunction in arrhythmic risk assessment, we conducted a systematic review and meta-analysis to evaluate its prognostic value for SCD and VA. METHODS: A systematic search of PubMed, Embase, and Web of Science was conducted from inception to February 2025. The primary endpoint was a composite of SCD or severe VA, including ventricular tachycardia, ventricular fibrillation, or appropriate implantable cardioverter-defibrillator therapy. RV dysfunction was defined as impaired RV fractional area change, RV ejection fraction, or RV strain. A random-effects model was used to calculate pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: Of 1296 identified articles, seven studies comprising 1475 patients met the inclusion criteria. RV dysfunction was present in 541 patients. The mean follow-up duration was 2.9 years. RV dysfunction was significantly associated with an increased risk of SCD and VA (OR 3.69; 95% CI 2.40-5.66; p < 0.01). Secondary analysis showed that patients who experienced SCD or VA had significantly lower RVFAC compared to those without events (MD - 5.67; 95% CI - 8.73 to - 2.60; p < 0.01), whereas LVEF did not differ significantly between groups (MD - 0.59; 95% CI - 4.10 to 2.92; p = 0.74). CONCLUSIONS: RV dysfunction is associated with an increased risk of SCD and VA, indicating that RV parameters may hold prognostic value in arrhythmic risk stratification.