BRITISH – Using Cardiac MRI to Guide ICD Therapy

Patients with non-ischaemic cardiomyopathy (NICM) and severely reduced left ventricular function are at increased risk of ventricular arrhythmias and sudden cardiac death. Traditionally, left ventricular ejection fraction (LVEF) has been a major factor used to determine whether a patient should receive an implantable cardioverter-defibrillator (ICD) for primary prevention. However, many patients who receive an ICD never require therapy from the device, while ICD implantation carries its own risks. n

Cardiovascular magnetic resonance (CMR) can identify myocardial scar, which is associated with an increased risk of ventricular arrhythmias and sudden cardiac death. The BRITISH trial is investigating whether CMR-detected scar can provide a more targeted approach to identifying patients who are most likely to benefit from an ICD. Its primary aim is to determine whether using CMR-detected myocardial scar to guide ICD therapy in patients with NICM and severe LV systolic dysfunction can reduce all-cause mortality. The primary endpoint is all-cause mortality at three years after the final participant is randomised.