Table 3 Recommendations for CMR in the guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death
Recommendation | Class | Level |
|---|---|---|
Recommendations for evaluation of patients presenting with newly documented ventricular arrhythmia | ||
In patients with newly documented ventricular arrhythmia (frequent premature ventricular contractions (PVCs), non-sustained ventricular tachycardia (NSVT), sustained monomorphic ventricular tachycardia (SMVT) and suspicion of structural heart disease other than coronary artery disease after initial evaluation, a CMR should be considered | IIa | B |
Recommendations for evaluation of sudden cardiac arrest survivors | ||
Coronary imaging and CMR with LGE are recommended for evaluation of cardiac structure and function in all sudden cardiac arrest survivors without a clear underlying cause | I | B |
Recommendations for evaluation of relatives of sudden arrhythmic death syndrome decedents | ||
Ambulatory cardiac rhythm monitoring and CMR may be considered in relatives of sudden arrhythmic death syndrome (SADs) decedents | IIb | C |
Recommendations for the management of patients with idiopathic premature ventricular complexes/ventricular tachycardia | ||
In patients with PVCs / ventricular tachycardia (VT) and a presentation not typical for an idiopathic origin, CMR should be considered, despite a normal echocardiogram | IIa | C |
Recommendations for the management of patients with premature ventricular complex-induced or premature ventricular complex aggravated cardiomyopathy | ||
In patients with suspected PVCs- induced cardiomyopathy, CMR should be considered | IIa | B |
Recommendations for risk stratification, sudden cardiac death prevention, and treatment of ventricular arrhythmias in dilated cardiomyopathy (DCM) / hypokinetic non-dilated cardiomyopathy (HNDCM) | ||
CMR with LGE should be considered in dilated cardiomyopathy (DCM) / hypokinetic non-dilated cardiomyopathy (HNDCM) patients for assessing the aetiology and the risk of ventricular arrhythmia (VA) / sudden cardiac death (SCD) | IIa | B |
ICD implantation should be considered in DCM / HNDCM patients with a LVEF < 50% and ≥ 2 risk factors (syncope, LGE on CMR, inducible sustained monomorphic VT (SMVT) at programmed electrical stimulation (PES), pathogenic mutations in LMNA, PLN, FLNC, and RBM 20 genes) | IIa | C |
Recommendations for diagnostic, risk stratification, sudden cardiac death prevention, and treatment of ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy | ||
In patients with suspected arrhythmogenic right ventricular cardiomyopathy (ARVC), CMR is recommended | I | B |
Recommendations for risk stratification, sudden cardiac death prevention, and treatment of ventricular arrhythmias in hypertrophic cardiomyopathy | ||
CMR with LGE is recommended in hypertrophic cardiomyopathy (HCM) patients for diagnostic work-up | I | B |
ICD implantation should be considered in HCM patients aged 16 years or more with an intermediate 5-year risk of SCD (≥ 4 to < 6%) and with (a) significant LGE at CMR (usually ≥ 15% of LV mass); or (b) LVEF < 50%; or (c) abnormal blood pressure response during exercise test; or (d) LV apical aneurysm; or (e) presence of sarcomeric pathogenic mutation | IIa | B |
ICD implantation may be considered in HCM patients aged 16 years or more with a low estimated 5-year risk of SCD (< 4%) and with (a) significant LGE at CMR (usually ≥ 15% of LV mass); or (b) LVEF < 50%; or (c) LV apical aneurysm | IIb | B |
Recommendations for implantable cardioverter defibrillator implantation in left ventricular non-compaction | ||
In patients with a left ventricular non-compaction (LVNC) cardiomyopathy phenotype based on CMR or echocardiography, implantation of an ICD for primary prevention of SCD should be considered to follow DCM / HNDCM recommendations | IIa | C |
Recommendations for risk stratification, sudden cardiac death prevention, and treatment of ventricular arrhythmias in neuromuscular diseases | ||
Invasive electrophysiological evaluation should be considered in patients with myotonic dystrophy and a PR interval ≥ 240 ms or QRS duration ≥ 120 ms or who are older than 40 years and have supraventricular arrhythmias or who are older than 40 years and have significant LGE on CMR | IIa | B |
Implantation of an ICD may be considered in patients with Duchenne/Becker muscular dystrophy and significant LGE at CMR | IIb | C |
Recommendations for risk stratification, sudden cardiac death prevention, and treatment of ventricular arrhythmias in cardiac sarcoidosis | ||
In patients with cardiac sarcoidosis who have a LVEF > 35% but significant LGE at CMR after resolution of acute inflammation, ICD implantation should be considered | IIa | B |
In patients with cardiac sarcoidosis who have a LVEF 35–50% and minor LGE at CMR, after resolution of acute inflammation, programmed electrical stimulation (PES) for risk stratification should be considered | IIa | C |
Recommendations for risk stratification and prevention of sudden cardiac death in athletes | ||
In athletes with positive medical history, abnormal physical examination, or ECG alterations, further investigations including echocardiography and/or CMR to confirm (or exclude) an underlying disease are recommended | I | C |