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Sudden
cardiac death (SCD) due to cardiac arrhythmia is with 300.000 – 400.000
patients a year in the United States alone a major cause of death in the
western civilisation. Treatment with an implantable cardioverter defibrillator (ICD)
is much used as prevention technique in high-risk patients to improve their chances
of survival. (1) In the Netherlands for example, 244
per mil inhabitants undergo an ICD implantation. (2) Even though ICD implantation is
used a lot as prevention technique, the recent DANISH-trial found out that it
does not lead to a reduction of long-term mortality in patients with
symptomatic heart failure not caused by coronary artery disease. Since only
11.5% of the patients implanted with an ICD receives a shock and placement of
an ICD comes along with a lot of possible adverse events, this reduction has
not yet been established. Simultaneously, 8.2% of the patients who do not
measure up to the current criteria of ICD placement die because of SCD. (3) This indicates that the current
guidelines for ICD placement needs to be improved.

Myocardial
fibrosis (MF) creates a substrate which facilitates re-entry circuits and is
thereby an important determinant in the pathogenesis of ventricular arrhythmias
which can lead to SCD. (4) Therefore, MF might be correlated with SCD. Myocardial
fibrosis can easily be assessed with cardiac MRI (CMR). (5) Despite of the possible relation of
MF with SCD and the ability to visualize it, the presence of MF is not used in
the current guidelines of ICD placement. (6)  

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Since we
need to improve the guidelines of ICD placement and myocardial fibrosis, though
not used in the current guidelines, might be correlated with deadly ventricular
arrhythmias, research has been done to the predictive value of MF for SCD,
measured with CMR. This study provides a review of the research done so far.

Methods

PubMed was
used as database in the literature search of this study. Only articles written in
the past 15 year (after 12-12-2002) were used in the literature search. Articles
were included based on MeSH terms (see figure 1). The remaining studies were
evaluated on the importance on the subject and excluded if they did not
contribute to the aim of the study to determine whether or not MF is
a prognostic factor for SCD in patients undergoing (evaluation of) ICD
implantation. Studies were also excluded when other techniques than CMR were
used. Only empirical studies were included. Case-report studies and pilot
studies were also excluded. Furthermore, articles were excluded when they differentiate
between monomorphic and polymorphic ventricular arrhythmias or tachycardias. Articles
about patients with cardiac sarcoidose as underlying disease were also excluded.

 

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