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How can cardiac imaging contribute in risk evaluation of ventricular arrhythmias?

This was a very interesting and exciting session that focused on the importance of new cardiac imaging modalities in the selection of patients for implantable cardioverter defibrillator (ICD) treatment and on the prognostic value of these imaging modalities in the prediction of arrhythmic events in different pathologies.
The first speaker, Professor Kisslo from Durham, US, in his excellent presentation underlined that there is strong evidence (the MADIT-CRT trial etc) that has already proven the usefulness of resynchronization therapy in combination with ICD implantation. In the subsequent parts of his talk, he elegantly demonstrated the relevance of different patterns of strain and strain rate imaging in the selection process and the prognostic value of mechanical dispersion in the prediction of arrhythmic events.
Professor Thor Edvardsen from Norway focused his presentation on the prediction of arrhythmias (and sudden cardiac death) by global longitudinal strain measured by speckle tracking echocardiography. He emphasized that the assessment of mechanical dispersion by echocardiography is helpful to identify patients prone to malignant arrhythmias. The mechanical dispersion determined by strain echocardiographic measurements predicts arrhythmic events even in patients with dilated cardiomyopathy.
Dr. Sophie Mavrogeni from Greece demonstrated the importance of cardiac magnetic resonance (CMR) imaging in the prediction of ventricular arrhythmias in different pathologies. She concluded that the detection of late enhancement in the left ventricle is predictive of ventricular tachycardia in both ischemic and non–ischemic heart disease; CMR is a method of choice in the diagnosis of myocarditis with normal left ventricular ejection fraction; CMR plays important role in the evaluation of patients with congenital heart disease and at high risk of ventricular arrhythmias.


In summary, all speakers convincingly demonstrated that both the new echocardiographic modalities and CMR play an important role in the management of patients with a high risk of fatal ventricular arrhythmias who are candidates for ICD implantation.




How can cardiac imaging contribute in risk evaluation of ventricular 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.

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