CMR GUIDEHot Line 1Devices & ArrhythmiasJAMA
Defibrillator Implantation Guided by CMR in Moderate Left Ventricular Ejection Fraction
Cardiovascular Magnetic Resonance to Guide Defibrillator Implantation for LVEF of 36% to 50%
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Presenting authorJoseph SelvanayagamCardiac Imaging · Sakarya UniversityJoseph Selvanayagam is Professor of Cardiovascular Medicine at Flinders University and a Senior Clinical Cardiologist at Flinders Medical Centre, where he is Director of Non-Invasive Cardiac Imaging. He is also Director of Cardiac Imaging Research at the South Australian Health and Medical Research Institute (SAHMRI). He graduated with first-class honours from the University of Adelaide in 1995, obtained FRACP in Cardiology in 2002, and completed a DPhil at the University of Oxford in 2005.
Overview
Does not support primary prevention ICD in LVEF 36-50% with scar; challenges CMR late gadolinium enhancement alone for defibrillator selection.
Key result
Implantation of a primary prevention ICD did not reduce the composite of sudden cardiac death or hemodynamically significant ventricular arrhythmia compared with an ILR (HR 0.76; 95% CI 0.37-1.58).
Discussion
CMR GUIDE has reported — post the first read.
Key Points
- Implantable cardioverter-defibrillator placement did not reduce sudden cardiac death or ventricular arrhythmia in patients with myocardial scar and ejection fraction of 36% to 50%.
- The primary outcome of sudden cardiac death occurred in 7.8% of defibrillator recipients versus 9.2% with loop recorders during 6.3 years of follow-up across 353 randomized adults.
- Randomized trial evidence indicates cardiovascular magnetic resonance assessment of late gadolinium enhancement alone cannot justify primary prevention defibrillator insertion.
Study Design
Type
RCT (n=353)
Blinding
Open-label
Randomization
Randomized
Multicenter
Yes
Structured PICO
Does a primary prevention implantable cardioverter-defibrillator (ICD) reduce sudden cardiac death or hemodynamically significant ventricular arrhythmia in patients with cardiomyopathy, LVEF 36% to 50%, and myocardial scar compared to an implantable loop recorder?
P
Population
353 adults with ischemic or nonischemic cardiomyopathy, LVEF 36% to 50%, and CMR-defined myocardial scar, followed for a median of 6.3 years.
I
Intervention
Primary prevention implantable cardioverter-defibrillator (ICD) (n=180)
C
Comparator
Implantable loop recorder (ILR) (n=173)
O
Outcome
Composite outcome of sudden cardiac death (SCD) or hemodynamically significant ventricular arrhythmia (HSVA)composite
In patients with an LVEF of 36% to 50% and CMR-defined myocardial scar, prophylactic ICD implantation did not significantly reduce the composite of sudden cardiac death or hemodynamically significant ventricular arrhythmia compared to an implantable loop recorder.
Main Result
Hazard Ratio: 0.76 (95% CI 0.37–1.58)
Absolute Event Rate: 7.8% vs 9.2%
Cite This Study
Selvanayagam et al. (Fri,) conducted a rct in Ischemic or nonischemic cardiomyopathy (n=353). Primary prevention implantable cardioverter-defibrillator (ICD) vs. Implantable loop recorder (ILR) was evaluated on Composite of sudden cardiac death (SCD) or hemodynamically significant ventricular arrhythmia (HSVA) (HR 0.76, 95% CI 0.37-1.58). Implantation of a primary prevention ICD did not reduce the composite of sudden cardiac death or hemodynamically significant ventricular arrhythmia compared with an ILR (HR 0.76; 95% CI 0.37-1.58).