1. Non ischemic cardiomyopathy and low burden of scar as revealed by an ECG-score: No need for a defibrillator in special patients after cardiac resynchronisation?
Grett M, Trappe HJ
Department of Cardiology and Angiology
University of Bochum, Germany

2. the modified Selvester-ECG-score (MSES)
changes in QRS-complex correlate with the extend of myocardial scar
estimation of scar by Selvester-Score shows high correlation with autopsy-measured myocardial infarct size
Selvester-Score was modified to deliver information in patients with conduction defect and non ischemic cardiomyopathy

3. the modified Selvester-ECG-score (MSES)
for detailed information on the history of the MSES:
A detailed guide for quantification of myocardial scar with the Selvester QRS score in the presence of electrocardiogram confounders.
Loring Z, Chelliah S, Selvester RH, Wagner G, Strauss DG.
J Electrocardiol Sep-Oct;44(5):544-54

4. Example Loring Z, Chelliah S, Selvester RH, Wagner G, Strauss DG.
J Electrocardiol Sep-Oct;44(5):544-54

5. Example Loring Z, Chelliah S, Selvester RH, Wagner G, Strauss DG.
J Electrocardiol Sep Oct;44(5):544-54

6. MSES as a prognostic tool
higher MSES correlates with greater risk for adequate ICD-therapies
Strauss, D.G., Poole, J.E., Wagner, G.S., Selvester, R.H., Miller, J.M., Anderson, J., Johnson, G., McNulty, S.E., Mark, D.B., Lee, K.L., Bardy, G.H., Wu, K.C. (2011).
An ECG index of myocardial scar enhances prediction of defibrillator shocks: an analysis of the Sudden Cardiac Death in Heart Failure Trial. Heart Rhythm 8 (1), 38-45
lower MSES predicts reverse remodeling by CRT
Sweeney, M.O., van Bommel, R.J., Schalij, M.J., Borleffs, C.J., Hellkamp, A.S., Bax, J.J. (2010)
Analysis of ventricular activation using surface electrocardiography to predict left ventricular reverse volumetric remodeling during cardiac resynchronization therapy. Circulation 121 (5),

7. MSES as a prognostic tool
higher MSES correlates with greater risk for adequate ICD-therapies
lower MSES predicts greater reverse remodeling by CRT
combining these findings with being convinced that reverse remodeling reduces the risk for sustained VT and the belief in a classic model of scar as a substrate and ischemia as a trigger for VT lead to our study

8. No need for a defibrillator in special patients after cardiac resynchronisation?
Retrospective subgroup analysis
74 pts who underwent CRT-D implantation
complete follow up of device interrogations for 3 years at our department
Exclusion: secondary prophylactic indication for ICD, upgrade from existing devices, long-QT, channelopathies

9. No need for a defibrillator in special patients after cardiac resynchronisation?
Median LVEF 20% (range 10,0%-29,0%)
median ECG-score 4 (0-12)
85% male
mean age 65,7 years
ischemic (ICM) 33 pts, non-ischemic (NICM) 41
25/74 suffered adequate ICD-therapy in 3 year period

10. No need for a defibrillator in special patients after cardiac resynchronisation?