Electrical cardiomyopathies contain the long QT syndrome (LQTS), the short QT syndrome (SQTS), the Brugada syndrome, and the catecholaminergic polymorphic ventricular tachycardia (CPVT). Patients diagnosed with an electrical cardiomyopathy have an increased risk of syncope and sudden cardiac death (SCD). Usually, we are dealing with young patients or even children. The prevalence of these diseases is low. No large prospective randomized studies exist with respect to outcome based on different clinical and genetic parameters. Thus, risk stratification in these patients is based on retrospective data from single- or multicenter registries.The implantable cardioverter defibrillator is the only reliable therapy in patients with Brugada syndrome and SQTS, as no pharmacological therapy has been proven to prevent SCD. In LQTS and CPVT, the primary therapy relies on beta-blockers. In high-risk patients, the ICD is indicated.In all electrical diseases, risk stratification is based on the clinical phenotype, including the electrocardiogram, the history of unexplained or disease-related syncope, and sudden cardiac arrest. In LQTS and CPVT, demographic data like age and gender are important factors for risk stratification. The genotype contributes to risk stratification only in LQTS and CPVT.Patients with electrical cardiomyopathies have to be risk-stratified individually based on the data and the current guidelines available.