Risk Stratification for Sudden Cardiac Death
Is It Too Late to Establish a Role for Cardiac MRI?
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- death, sudden, cardiac
- defibrillators, implantable
- gadolinium DTPA
- tachycardia, ventricular
- ventricular ejection fraction
Article, see p 2106
Automatic detection and transvenous or subcutaneous defibrillation of malignant ventricular arrhythmias by implantable cardioverter defibrillators are vital for management of patients at high risk for sudden cardiac death. Guidelines and appropriate use criteria based on data from several clinical trials support prophylactic defibrillator implantation in patients with symptoms of heart failure and left ventricular ejection fraction ≤35%.1,2 Yet, existing guidelines direct defibrillator implantation to a small subset of the overall population at risk for sudden death, and with an average annual appropriate shock rate of 5.1%, many patients that receive an implantable defibrillator never require appropriate therapies and are exposed to device-related risks.3,4 The recent DANISH trial (Defibrillator Implantation in Patients with Non-Ischemic Systolic Heart Failure) found no mortality benefit with prophylactic defibrillator implantation in patients with symptomatic heart failure and nonischemic cardiomyopathy.5 Thus, additional data are necessary to refine patient selection among patients with nonischemic cardiomyopathy that currently meet defibrillator implantation criteria. At the same time, criteria to identify high risk of sudden cardiac death among patients that are currently excluded must evolve. As many as 80% of those who experience out-of-hospital cardiac arrests would …