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Imaging and arrhythmias

ESC Congress 2010

This focus session began with a review of the role of MIBG nuclear imaging in patients with arrhythmias and heart failure. Johani Knuuti summarized the evidence in this field and came to the conclusion that there is some interesting and promising data indicating that indeed the lack of myocardial innervation demonstrated by reduced MIBG uptake was associated with a poorer prognosis but that the evidence was not good enough to recommend such imaging in all patients with heart failure. Unfortunately, there are no data indicating in which subset of patients this technique (which costs approx. 500 Euros) should be employed, as there are no large scale clinical trials.

Thomas Marwick summarized the role of echocardiography in patients with arrhythmias and heart failure. He first pointed to the fact that 2D-echocardiography may give erroneous results when determining left ventricular ejection fraction, especially when eye-balling is used. He recommended to use 3D-echocardiography on myocardial strain rate imaging instead. For the selection of patients for CRT, the PROSPECT trial showed no advantage of applying echocardiographic techniques. However, the speaker pointed out that the latest technologies were not employed in this trial. Furthermore, viability testing was not carried out in all patients. He then summarised the evidence for using echocardiography in the selection of patients for primary prophylactic ICD-implantation. However, the current evidence was not that convincing. This was also true for applying echocardiography in patients with AV-node re-entry tachycardia or atrial tachycardias.

The role of scar imaging by CMR was discussed by Sanjay Prasad. He focused especially on cardiomyopathies and showed new data indicating that the presence and the extent of myocardial scarring might help to select patients for ICD-implantation who might benefit most from this form of therapy. This pertained both to HCM and DCM. In ischemic patients, characterization of the peri-infarct zone might be helpful to assess the risk of the patient and hence make correct decisions about the need to implant such a device.




Imaging and arrhythmias

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.