Imaging for risk stratification of sudden cardiac death

Sudden cardiac death (SCD) can be effectively prevented with the use of implantable cardioverter-defibrillator (ICD). Current guidelines advocate an ICD for primary prevention in the presence of an left ventricular ejection fraction (LVEF) ≤ 35%. The majority of individuals that experience SCD, however, have an LVEF > 35%. Multimodality cardiac imaging has the ability to visualize the three factors responsible for arrhythmia-mediated SCD, namely substrate, trigger and modulator. Advances in cardiac imaging techniques have allowed improved SCD risk stratification, especially in the group of patients with an LVEF > 35%. However, clinical integration of cardiac imaging for SCD risk stratification will require more comparative data between modalities and parameters, as well as evidence of an impact on outcomes. The current review represents an update on the use of multimodality imaging techniques for SCD risk stratification.