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

Jonathan Chrispin; Faisal M Merchant; Neal K Lakdawala; Katherine C Wu; Gordon F Tomaselli; Rachita Navara; Estelle Torbey; Amrut V Ambardekar; Rajesh Kabra; Eloisa Arbustini; Jagat Narula; Maya Guglin; Christine M Albert; Sumeet S Chugh; Natalia Trayanova; Jim W Cheung

doi:10.1016/j.jacc.2023.05.064

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

J Am Coll Cardiol. 2023 Aug 22;82(8):735-747. doi: 10.1016/j.jacc.2023.05.064.

Authors

Jonathan Chrispin¹, Faisal M Merchant², Neal K Lakdawala³, Katherine C Wu⁴, Gordon F Tomaselli⁵, Rachita Navara⁶, Estelle Torbey⁷, Amrut V Ambardekar⁸, Rajesh Kabra⁹, Eloisa Arbustini¹⁰, Jagat Narula¹¹, Maya Guglin¹², Christine M Albert¹³, Sumeet S Chugh¹³, Natalia Trayanova¹⁴, Jim W Cheung¹⁵

Affiliations

¹ Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address: chrispin@jhmi.edu.
² Department of Medicine, Emory University, Atlanta, Georgia, USA.
³ Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁴ Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁵ Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
⁶ Division of Cardiac Electrophysiology, University of California, San Fransisco, California, USA.
⁷ Division of Electrophysiology, Brown University, Providence, Rhode Island, USA.
⁸ Department of Medicine, Division of Cardiology, University of Colorado, Aurora, Colorado, USA.
⁹ Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA.
¹⁰ Center for Inherited Cardiovascular Diseases, IRCCS Foundation Policlinico San Matteo, Pavia, Italy.
¹¹ McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA.
¹² Advanced Heart Failure and Transplant, Indiana University School of Medicine, Indianapolis, Indiana, USA.
¹³ Cardiac Electrohysiology, Cedars Sinai Smidt Heart Institute, Los Angeles, California, USA.
¹⁴ Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA.
¹⁵ Division of Cardiology, Weill Cornell Medicine, New York, New York, USA.

PMID: 37587585
DOI: 10.1016/j.jacc.2023.05.064

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.

Publication types

Review

MeSH terms

Cardiomyopathies* / complications
Cardiomyopathies* / therapy
Death, Sudden, Cardiac / epidemiology
Death, Sudden, Cardiac / etiology
Death, Sudden, Cardiac / prevention & control
Heart Failure*
Humans
Stroke Volume
Ventricular Function, Left