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Review
. 2023 Aug 22;82(8):735-747.
doi: 10.1016/j.jacc.2023.05.064.

Risk of Arrhythmic Death in Patients With Nonischemic Cardiomyopathy: JACC Review Topic of the Week

Jonathan Chrispin  1 , Faisal M Merchant  2 , Neal K Lakdawala  3 , Katherine C Wu  4 , Gordon F Tomaselli  5 , Rachita Navara  6 , Estelle Torbey  7 , Amrut V Ambardekar  8 , Rajesh Kabra  9 , Eloisa Arbustini  10 , Jagat Narula  11 , Maya Guglin  12 , Christine M Albert  13 , Sumeet S Chugh  13 , Natalia Trayanova  14 , Jim W Cheung  15
Affiliations
Free article
Review

Risk of Arrhythmic Death in Patients With Nonischemic Cardiomyopathy: JACC Review Topic of the Week

Jonathan Chrispin et al. J Am Coll Cardiol. .
Free article

Abstract

Nonischemic cardiomyopathy (NICM) is common and patients are at significant risk for early mortality secondary to ventricular arrhythmias. Current guidelines recommend implantable cardioverter-defibrillator (ICD) therapy to decrease sudden cardiac death (SCD) in patients with heart failure and reduced left ventricular ejection fraction. However, in randomized clinical trials comprised solely of patients with NICM, primary prevention ICDs did not confer significant mortality benefit. Moreover, left ventricular ejection fraction has limited sensitivity and specificity for predicting SCD. Therefore, precise risk stratification algorithms are needed to define those at the highest risk of SCD. This review examines mechanisms of sudden arrhythmic death in patients with NICM, discusses the role of ICD therapy and treatment of heart failure for prevention of SCD in patients with NICM, examines the role of cardiac magnetic resonance imaging and computational modeling for SCD risk stratification, and proposes new strategies to guide future clinical trials on SCD risk assessment in patients with NICM.

Keywords: cardiac magnetic resonance imaging; computational modeling; nonischemic cardiomyopathy; sudden cardiac death; ventricular arrhythmias.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Chrispin has received consulting fees from Biosense Webster; and has received honorarium from Abbott. Dr Navara has equity ownership in SafeBeat Rx. Dr Torbe has ownership of Boston Scientific stocks. Dr Cheung has received consulting fees from Abbott, Biotronik, and Boston Scientific; has received research grant support from Boston Scientific; and has received fellowship grant support from Abbott, Biosense, Biotronik, Boston Scientific, and Medtronic. Dr Lakdawala has received research support from Pfizer Inc; and has received consulting fees from Pfizer Inc, Bristol Myers Squibb, Cytokinetics, and Tenaya Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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