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  • Open Access

The Gootter registry. Guiding our outcomes to terminal electrical rhythms - A CMR study of ICD events

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Journal of Cardiovascular Magnetic Resonance201012(Suppl 1):P300

https://doi.org/10.1186/1532-429X-12-S1-P300

Published: 21 January 2010

Keywords

  • Sudden Cardiac Death
  • Delay Contrast Enhancement
  • Preserve LVEF
  • Prevention Implant
  • Electrical Rhythm

Introduction

Sudden cardiac death (SCD) remains a major health problem, accounting for nearly 1000 deaths in the US daily. Clinical trials have proved a survival benefit with ICD implantation in patients with a LVEF <30-35%. However, it has been estimated that of the 2 million ICD's currently implanted, only 5% ever fire to correct a deadly arrhythmia. Also, many patients who would benefit from a prophylactic ICD are not considered candidates for implantation suggesting our criteria are inaccurate. Clearly, an accurate predictor of deadly cardiac arrhythmias has yet to be identified.

Purpose

Cardiac MRI (CMR) is noninvasive, non-irradiating, and can identify even small regions of LV myocardial fibrosis. These investigators believe that this micro-fibrosis is the common underlying substrate for deadly arrhythmias from multiple ischemic and non-ischemic etiologies.

Methods

This study was approved by the IRB. All patients receiving ICD for either primary or secondary prevention were enrolled. Comprehensive CMR examination (1.5 T GE Sigma v14x) including myocardial delayed contrast enhancement (E) was performed in 42 patients over a period of 3 years (185 patients were screened and 143 were excluded for patient refusal, pacer or ICD leads, unable to schedule prior to ICD implantation, and claustrophobia). Patients were followed routinely in the ICD clinic and monitored for appropriate ICD shocks or anti-tachycardia pacing (ATP), ventricular tachycardia () and cardiac death (primary end-points). Secondary end-points included non-sustained (NS), supraventricular tachycardia (S), and non-cardiac death. Continuous variables were expressed as mean + SD. CMR findings in patients without events yet to be analyzed.

Results

Mean age is 59 +/- 12 years. 41/42 patients available for follow-up (480 +/- 300 days). ICD implantation performed within 12 + 18 days after CMR. There were 37 primary and 5 secondary prevention implants. 7(17%) patients experienced primary (N = 3) or secondary (N = 4) end-points. Of these, 3 had >10% and 3 had < 10% ratio of E/LV mass. 1(17%) patient had an endocardial (CAD) E pattern and 5(83%) a non-CAD E pattern. There were 2 deaths, 1 pulmonary embolism and 1 SCD (<24 hours after CMR prior to ICD), Table 1.
Table 1

Characteristics of 7 patients with episodes

S. NO

Age

Sex

Events

LVEF (%)

E

%E

Location of E

CAD

Prevention

1

64

M

3 episodes of NS

No shock

28

N/A

GFR <30 ml/min/1.73 m2

N/A

N/A

Yes

Primary

2

66

M

3 episodes of NS

No shock

23

Base to distal anterior, septal and lateral wall

14.5

Mid myocardial and subepicardial

Yes

Primary

3

61

M

1 NS

1 S episode

No shock

Expired from PE

28

Mid and distal inferior wall

2.7

Mid myocardial

Yes

Primary

4

61

M

3 episodes of NS

1 episode of terminated by ATP

1 episode of S

65

Patchy fibrosis mid anterior wall

0.7

Mid myocardial

No

Secondary

5

50

M

expired within 24 hrs of CMR study

21

Basal inferior and antero-septal wall

2.1

Subepicardial

No

Primary

6

67

M

2 episodes of terminated with shocks

7 episodes of S

44

Basal anterior and mid to distal inferior wall

10.8

Mid myocardial

Yes

Secondary

7

82

M

1 episode of S

46

Basal to distal anterior and antero-septal wall

15

Subendocardial and mid myocardial

Yes

Secondary

Conclusion

This is an early report from the GOOTTER registry on patients with short term events after ICD implantation. 7(17%) endpoints have occurred. 3(7.7%) had a primary event (1 death) >1 year follow up.

LVEF was a poor discriminator for SCD prediction. Fibrosis is a common denominator for a deadly arrhythmia substrate as seen in all the patients with events even those who have a preserved LVEF.

Authors’ Affiliations

(1)
Sarver Heart Center, University of Arizona, Tucson, USA

Copyright

© Kalra and Sorrell; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.

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