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Updated: Dec 9, 2025

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

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Ventricular arrhythmia risk is associated with myocardial scar but not with response to cardiac resynchronization

Markus Linhart1, Adelina Doltra2, Juan Acosta3,4

  • 1Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|September 8, 2020
PubMed

Insights

Myocardial scar presence predicts sudden cardiac death (SCD) risk in patients undergoing cardiac resynchronization therapy (CRT), independent of CRT response. Improved survival requires both scar absence and CRT response.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Electrophysiology

Background:

  • Sudden cardiac death (SCD) risk stratification in patients referred for cardiac resynchronization therapy (CRT) is challenging.
  • CRT-mediated improvements in left ventricular ejection fraction (LVEF) can lead to loss of indication for primary prevention implantable cardioverter-defibrillators (ICDs).
  • Myocardial scar is increasingly recognized as a crucial factor in risk prediction.

Purpose of the Study:

  • To evaluate the prognostic significance of myocardial scar in patients undergoing CRT.
  • To assess the impact of myocardial scar on risk prediction, considering echocardiographic CRT response.

Main Methods:

  • Prospective enrollment of patients indicated for CRT.
  • Delayed-enhancement cardiac magnetic resonance imaging (DE-CMR) to assess myocardial scar.
  • Median follow-up of 45 months for a composite outcome of sustained ventricular arrhythmia, appropriate ICD therapy, or SCD.

Main Results:

  • Myocardial scar was present in 95% of ischemic cardiomyopathy (ICM) and 45% of non-ischemic cardiomyopathy patients.
  • Myocardial scar was the sole significant predictor of the primary outcome (OR 27.7), independent of CRT response.
  • Absence of myocardial scar combined with CRT response was associated with favorable overall survival.

Conclusions:

  • Malignant arrhythmic events and SCD are primarily dependent on the presence of myocardial scar, not CRT response.
  • All-cause mortality reduction is achieved only when myocardial scar is absent and CRT response is present.
Abstract

Keywords:
Cardiac resynchronization therapyLeft ventricular remodellingMyocardial scarRisk predictionSudden cardiac deathVentricular arrhythmia

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