Myocardial fibrosis and the effect of primary prophylactic defibrillator implantation in patients with non-ischemic systolic heart failure—DANISH-MRI

Elming, Marie Bayer; Hammer-Hansen, Sophia; Voges, Inga; Nyktari, Eva; Raja, Anna Axelsson; Svendsen, Jesper Hastrup; Pehrson, Steen; Signorovitch, James; Køber, Lars; Prasad, Sanjay; Thune, Jens Jakob

doi:10.1016/j.ahj.2019.10.020

Cited by 46 publications

(37 citation statements)

References 32 publications

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“…The usefulness of CMR in assessing arrhythmic risk has already been proven in patients with NICM. In the DANISH study's substudy, the DANISH-MRI study ( 55 ) fibrosis was shown to be an independent predictor for all-cause mortality and arrhythmic events. Similarly, an observational study conducted by Gutman et al ( 56 ) demonstrated a survival benefit associated with the implantation of an ICD for primary prevention in NICM only for patients with scar tissue on CMR, Finally, in a retrospective, very large observational study involving 1,165 patients with dilated cardiomyopathy who underwent LGE-CMR ( 57 ), LGE in CMR was found to be a very strong predictor of ventricular arrhythmias and sudden death.…”

Section: Clinical Applications Of Lge-cmr In Vt Ablationmentioning

confidence: 99%

Cardiac Magnetic Resonance for Ventricular Tachycardia Ablation and Risk Stratification

Roca‐Luque

Mont-Girbau

2022

Front. Cardiovasc. Med.

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Ventricular tachycardia is the most frequent cause of sudden cardiovascular death in patients with structural heart disease. Radiofrequency ablation is the treatment cornerstone in this population. Main mechanism for structural heart disease-related ventricular tachycardia is re-entry due to presence of slow conduction area within the scar tissue. Electroanatomical mapping with high density catheters can elucidate the presence of both scar (voltage maps) and slow conduction (activation maps). Despite the technological improvements recurrence rate after ventricular tachycardia ablation is high. Cardiac magnetic resonance has demonstrated to be useful to define the location of the scar tissue in endocardium, midmyocardium and/or epicardial region. Furthermore, recent studies have shown that cardiac magnetic resonance can analyse in detail the ventricular tachycardia substrate in terms of core scar and border zone tissue. This detailed tissue analysis has been proved to have good correlation with slow conduction areas and ventricular tachycardia isthmuses in electroanatomical maps. This review will provide a summary of the current role of cardiac magnetic resonance in different scenarios related with ventricular tachycardia in patients with structural heart disease, its limitations and the future perspectives.

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Section: Clinical Applications Of Lge-cmr In Vt Ablationmentioning

confidence: 99%

Cardiac Magnetic Resonance for Ventricular Tachycardia Ablation and Risk Stratification

Roca‐Luque

Mont-Girbau

2022

Front. Cardiovasc. Med.

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“…Fibrosis itself has been identified as a risk factor for mortality in DCM patients as the presence of LGE has been associated with increased VT occurrence and with overall mortality [107,108]. In addition, the complexity and extent of myocardial scars have been associated with VT incidence and mortality [109,110].…”

Section: Structural Remodelingmentioning

confidence: 99%

Electrical Ventricular Remodeling in Dilated Cardiomyopathy

Mages

Gampp

Syren

et al. 2021

Cells

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Ventricular arrhythmias contribute significantly to morbidity and mortality in patients with heart failure (HF). Pathomechanisms underlying arrhythmogenicity in patients with structural heart disease and impaired cardiac function include myocardial fibrosis and the remodeling of ion channels, affecting electrophysiologic properties of ventricular cardiomyocytes. The dysregulation of ion channel expression has been associated with cardiomyopathy and with the development of arrhythmias. However, the underlying molecular signaling pathways are increasingly recognized. This review summarizes clinical and cellular electrophysiologic characteristics observed in dilated cardiomyopathy (DCM) with ionic and structural alterations at the ventricular level. Furthermore, potential translational strategies and therapeutic options are highlighted.

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“…117 However, depending on the suspicion degree it is desirable to consider implanting a long-lasting heart monitor. In recent years, promising information has been generated regarding the usefulness of various cardiac magnetic resonance techniques to assess heterogeneity, location and extent of fibrosis as a marker of sudden cardiac death, 118,119 at the moment its widespread use is not recommended for decision-making in isolation until there are clinical trials available, currently the CMR GUIDE (Cardiovascular 120 While the defibrillator significantly reduces sudden deaths, patients with recurrent ventricular tachycardia despite OMT and antiarrrhythmic management with amiodarone should be considered for catheter ablation rather than escalation of antiarrrhythmic treatment. This is based on recent evidence in which the invasive strategy reduced the death risk rate, recurrence of ventricular tachycardia or ICD discharges by up to 28%.…”

Section: It Is Recommended To Implantable Cardioverter Defibrillators (Icds) In Patients With Hf-ref Who Despite Having Optimal Medical Tmentioning

confidence: 99%