Cardiac Magnetic Resonance in Sudden Cardiac Arrest Survivors

S udden cardiac arrest (SCA) is a major challenge in medi- cine despite significant advances in cardiology over the last few decades.Identification of causes of SCA has major implications for patient management, primary and secondary prevention of sudden cardiac death, and all-cause mortality.SCA predominantly affects individuals with underlying heart disease, especially ischemic heart disease occurring 6 to 9 times more often in postinfarction patients than in patients without myocardial infarction. 1 In the landmark Maastricht Circulatory Arrest Registry, 1 among 224 SCA victims, only 4% were because of an acute myocardial infarction but 92 of them (41%) had a prior myocardial infarction at a median of 9 years before SCA.Furthermore, the incidence of SCA is substantially increasing after the age of 65 years in males and later in females, coinciding with an increasing incidence of ischemic heart disease in this population.2 However, the incidence and risk of SCA in ischemic patients has decreased over the past 2 decades because of primary coronary intervention, widespread use of statins, and other contemporary medications.3 At the same time, the relative proportion of nonischemic causes of SCA is increasing and plays a particularly important role at the age <65 years.4,5 Ruling out coronary disease as a cause of SCA is an initial step of diagnosis, but subsequent differential diagnosis of nonischemic causes remains challenging.