Device Prevention of Sudden Cardiac Death
Monday, April 4, 8:00-9:30 AM

Ventricular scar tissue can interfere with appropriate shock therapy from an implantable device. Researchers have been trying to devise algorithms to better predict who will and who will not respond to implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy (CRT) devices.

Researchers are examining various ways that echo, CT, SPECT and PET could potentially help identify patients better suited for implantable devices or help identify better positioning of the leads.

Recently, a new ultrasound imaging software, which uses multiharmonic phase analysis to allow physicians to more accurately diagnose and treat heart failure patients, was sold by Emory University to Syntermed. It is designed to rapidly determine which heart failure patients will benefit from CRT with advances over traditional echo including better image clarity, 3D perfusion images, an automated process that eliminates variations in interpretation, and rapid and objective physician assessment of dyssynchrony.

Researchers at the Leiden University Medical Center are using myocardial perfusion SPECT to assess LV end-systolic volume, LV end-diastolic volume and LV ejection fraction in advanced heart failure patients who were to be implanted with cardiac resynchronization therapy to better determine whose therapy will be successful.

Researchers from Massachusetts General Hospital in Boston have found that CT-derived changes in LV wall thickness correlated best with the extent of dyssynchrony seen in heart failure patients with wide and narrow QRS, followed by LV wall motion and then LV volume. They said the ideal CT exam would be done before implantation and would assess the pulmonary veins, evaluate the ventricles for dyssynchrony to target the area that is most delayed and identify scar tissue to help facilitate lead placement.

There is a lot of ongoing research regarding implantable device success and this session of "Oral Contributions" should give participants a bird's eye view of the cutting-edge research in the field.

Guided by co-chairs Drs. Joseph E. Marine, from Johns Hopkins University in Baltimore, and Steven M. Markowitz, MD, from Weill Cornell Medical College in New York City, researchers will detail the work that they and their young assistants have been toiling over to help these patients.

Speaker information
  • Michael Robert Gold, MD, PhD, et al, Medical University of South Carolina, Charleston -- Left Ventricular Reverse Remodeling Predicts Mortality: Results from the REVERSE Study
  • Valentina Kutyifa, MD, et al, University of Rochester Medical Center, Rochester, N.Y. -- Left Ventricular Lead Position and the Risk of Ventricular Arrhythmias in the MADIT-CRT Study
  • Peng Gao, MD, et al, Robarts Research Institute, London, Ontario -- Ischemic or Non-Ischemic Myocardial Scar Quantification Predicts Future Arrhythmic Events in Candidates for Primary Prevention ICD
  • Alon Barsheshet, MD, University of Rochester Medical Center, Rochester, N.Y. -- Reverse Remodeling and the Risk of Ventricular Tachyarrhythmias in MADIT-CRT
  • Akif A. Mohammed, MD, Metro Health Medical Center, Cleveland -- Single versus Dual Chamber Implantable Cardioverter Defibrillators: Are Single Chamber Devices Really Obsolete?