Cardiac breakthrough offers potentially life-saving treatment for more patients

A more than decade-long medical trial has opened the way for potentially life-saving treatment options for patients with mild-to-moderate heart conditions.

Internationally recognised cardiac expert Flinders University Professor Joseph Selvanayagam, from Adelaide’s Heart & Vascular, presented his findings to the 2026 European Society of Cardiology Congress in Munich on Friday. And the breakthrough has been published in the prestigious Journal of the American Medical Association (JAMA).

The trial, involving 18 sites across Australia, Germany and the United Kingdom, examined whether a medical device currently used for patients with severe heart conditions could treat a wider range of patients.

An implantable cardioverter-defibrillator (ICD) is a small device placed in the body that can detect and correct dangerous heart rhythms that may otherwise cause sudden cardiac death. ICDs are currently only offered to patients with severely reduced heart function. 

Professor Selvanayagam’s research investigated another group of patients with mild-to-moderate heart dysfunction; a left ventricular ejection fraction (LVEF of 36-50%); and scarring in the heart muscle identified by cardiac MRI. The trial examined whether ICD implantation could reduce sudden cardiac death or serious ventricular arrhythmia in this group of patients.

While the trial did not identify a statistically significant reduction with ICD use in the primary endpoint of sudden cardiac death or serious ventricular arrhythmia across all age groups, it did so in a pre-specified analysis of patients younger than 70 years. Further, ICD implantation was associated with a reduction in the secondary endpoint of sudden cardiac death in the total cohort. This is the first randomised trial designed to help inform clinicians in deciding about ICD implantation in patients with heart scarring and an LVEF of 36-50%.

“An ICD is like having a personal paramedic for your heart, 24/7,” Prof Selvanayagam said.

“But the treatment gap right now is that most patients who die suddenly from a heart event don’t have underlying severe heart dysfunction, so currently don’t get offered an ICD as it is outside of accepted treatment guidelines. 

“This research has made a new finding that could potentially save lives.

“The reduction in sudden cardiac death and the benefit observed in younger patients provide important insights for individual treatment decisions.

“If you have mild-moderately reduced heart function due to a cardiomyopathy or previous heart attack then you should have a cardiac MRI.

“If you then have significant scarring in your heart MRI, you should probably have a discussion with your cardiologist about whether an ICD should be implanted, particularly if you are less than 70 years.”

Funding and disclosures:
The trial was funded by Biotronik, Bayer, Cardiac Imaging Research South Australia. 
Professor Selvanayagam reports Research Contracts: Biotronik, National Heart Foundation Australia, NHMRC Australia, Sanofi, Pfizer, Honya
Consulting/Advisory Board: AstraZeneca, BMS, Sanofi, Pfizer, Boehringer-Ingelheim, Novartis, Bayer, Amicus, CSL 

About Professor Joseph Selvanayagam
Professor Selvanayagam is an internationally recognised authority in Cardiac Imaging (Cardiac MRI, Cardiac CT and Echocardiography), trained in Adelaide and Oxford.  He is SCMR Level 3 board certified in Cardiac MRI and Australian conjoint committee Level A certified in Cardiac CT. He currently holds the Chair of Cardiovascular Medicine at Flinders University and is a Senior Clinical Cardiologist at Flinders Medical Centre, where he is the Director of Non-Invasive Cardiac Imaging. He is also the Director of Cardiac Research and Clinical Trials at Flinders. Prof Selvanayagam has published ~600 peer-reviewed manuscripts, abstracts, and book chapters. (Read more) Prof Selvanayagam is currently consulting from the following locations: Flinders Private Hospital, Calvary Private Hospital, Hawthorn, Mawson Lakes, Mount Gambier

About Heart and Vascular 
Heart and Vascular Clinics offer the highest level of expertise in cardiovascular services in Adelaide and Country South Australia. We provide a large, diverse, and progressive private cardiology service with state-of-the-art facilities for patient consulting, non-invasive cardiac testing (including advanced cardiac imaging), coronary/structural intervention, heart failure/cardiomyopathy management and advanced cardiac electrophysiology.