{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:10:37Z","timestamp":1788959437320,"version":"build-2803163510"},"reference-count":24,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Creavo Medical Technologies"},{"id":[{"id":"https:\/\/ror.org\/007gcc553","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Primary-prevention implantable cardioverter-defibrillator (ICD) selection remains dominated by left ventricular ejection fraction and clinical heart failure markers, which incompletely distinguish between patients who will experience ventricular arrhythmia and those whose prognosis is limited by competing non-arrhythmic mortality. The Magneto-SCD trial recently reported novel rotation-based magnetocardiography (MCG) indices associated with future appropriate ICD therapies. This substudy explores whether MCG Rotation Score provides incremental information in primary-prevention ICD recipients, particularly beyond NYHA status and MADIT-arrhythmic and non-arrhythmic risk scores. Methods: We included all Magneto-SCD trial participants with a primary-prevention indication with non-missing follow-up\/MCG Rotation Score data. The full primary-prevention cohort comprised 54 participants; the post-MI subgroup comprised 28. The primary endpoint was time to first appropriate ICD therapy. Death without prior therapy was used as a pragmatic competing endpoint and not assumed to represent adjudicated non-arrhythmic death. Appropriate shock was a secondary endpoint. Two-year cumulative incidence functions were estimated using Aalen\u2013Johansen methods. Cause-specific Cox models assessed Rotation Score alone and after addition to MADIT-derived scores; nested likelihood-ratio tests evaluated model fit. Results: Of 104 participants, 90 had analysable MCG data and 65 had a primary-prevention ICD indication; after exclusions for missing patients, 54 patients remained (mean age 63.8 \u00b1 13.2 yrs, 45(83.3%) male). Appropriate ICD therapies occurred in 10 (18.5%), including appropriate ICD shock in eight (14.8%); 10 patients (18.5%) died without prior therapy. The median follow-up was 1211.5 days (IQR 793.5\u20131396.0). Each SD increase in Rotation Score was associated with appropriate ICD therapy with HR 1.64 (95% CI 0.93\u20132.87; p = 0.086), appropriate ICD shock with HR 2.07 (95% CI 1.15\u20133.72; p = 0.015), death without prior therapy with HR 1.08 (95% CI 0.54\u20132.17; p = 0.824), and death without prior ICD shock with HR 0.95 (95% CI 0.48\u20131.90; p = 0.890). Adding Rotation Score did not significantly improve the primary therapy model beyond MADIT components (LRT p = 0.065) or MADIT benefit score (LRT p = 0.109). Model fit improved for the secondary appropriate ICD shock endpoint when Rotation Score was added to MADIT components (LRT p = 0.016), based on eight shock events. Conclusions: Rotation Score showed an association pattern more closely aligned with arrhythmic endpoints, particularly appropriate ICD shock, than with death without prior therapy. Incremental prognostic value for the primary endpoint was not established. These findings are hypothesis-generating and require confirmation in adequately powered, prospectively designed and externally validated cohorts before any role in clinical risk stratification or ICD decision-making can be determined.<\/jats:p>","DOI":"10.3390\/jcm15186985","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T12:26:11Z","timestamp":1788956771000},"page":"6985","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Magnetocardiographic Rotation Score and Arrhythmic Endpoints in Primary-Prevention ICD Recipients: An Exploratory Substudy of the Magneto-SCD Trial"],"prefix":"10.3390","volume":"15","author":[{"given":"Thomas","family":"Lachlan","sequence":"first","affiliation":[{"name":"Institute for Cardio-Metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK"},{"name":"Department of Life Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0037-3723","authenticated-orcid":false,"given":"Hejie","family":"He","sequence":"additional","affiliation":[{"name":"Institute for Cardio-Metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK"},{"name":"Department of Life Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Miller","sequence":"additional","affiliation":[{"name":"School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nakul","family":"Chandan","sequence":"additional","affiliation":[{"name":"Institute for Cardio-Metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK"},{"name":"Centre for Health and Life Sciences, Coventry University, Coventry CV1 5FB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taesoon","family":"Hwang","sequence":"additional","affiliation":[{"name":"Institute for Cardio-Metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK"},{"name":"Department of Life Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoaib","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Department of Cardiology, George Eliot Hospital, Nuneaton CV10 7DJ, UK"},{"name":"Department of Cardiology, Warwick Hospital, South Warwickshire University NHS Foundation Trust, Warwick CV34 5BW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Beadle","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Warwick Hospital, South Warwickshire University NHS Foundation Trust, Warwick CV34 5BW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Worcester Royal Hospital, Worcester WR5 1DD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjiv","family":"Petkar","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Wolverhampton Heart Centre, Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2056-5482","authenticated-orcid":false,"given":"Ven Gee","family":"Lim","sequence":"additional","affiliation":[{"name":"Institute for Cardio-Metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK"},{"name":"Department of Life Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK"},{"name":"Centre for Health and Life Sciences, Coventry University, Coventry CV1 5FB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter K.","family":"Kimani","sequence":"additional","affiliation":[{"name":"Department of Life Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3962-5118","authenticated-orcid":false,"given":"Faizel","family":"Osman","sequence":"additional","affiliation":[{"name":"Institute for Cardio-Metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK"},{"name":"Department of Life Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK"},{"name":"Centre for Health and Life Sciences, Coventry University, Coventry CV1 5FB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"ref_1","first-page":"euad203","article-title":"Risk stratification of sudden cardiac death: A review","volume":"25","author":"Garcia","year":"2023","journal-title":"EP Eur."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3997","DOI":"10.1093\/eurheartj\/ehac262","article-title":"2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death","volume":"43","author":"Zeppenfeld","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1056\/NEJMoa013474","article-title":"Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction","volume":"346","author":"Moss","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1056\/NEJMoa043399","article-title":"Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure","volume":"352","author":"Bardy","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1964","DOI":"10.1093\/eurheartj\/eht109","article-title":"Risk stratification after myocardial infarction: Is left ventricular ejection fraction enough to prevent sudden cardiac death?","volume":"34","author":"Dagres","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1676","DOI":"10.1093\/eurheartj\/ehaa1057","article-title":"Predicted benefit of an implantable cardioverter-defibrillator: The MADIT-ICD benefit score","volume":"42","author":"Younis","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.ahj.2025.08.020","article-title":"Rationale and design of the comparative effectiveness of ICD vs non-ICD therapy in contemporary heart failure patients at a low risk for arrhythmic death (CONTEMP-ICD) trial","volume":"291","author":"Goldenberg","year":"2026","journal-title":"Am. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.ahj.2025.07.071","article-title":"PRevention Of sudden cardiac death aFter myocardial Infarction by Defibrillator implantation: Design and rationale of the PROFID EHRA randomized clinical trial","volume":"291","author":"Dagres","year":"2026","journal-title":"Am. Heart J."},{"key":"ref_9","first-page":"151","article-title":"Magnetocardiography: Current status and perspectives. Part II: Clinical applications","volume":"3","author":"Tavarozzi","year":"2002","journal-title":"Ital. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"015008","DOI":"10.1088\/2057-1976\/3\/1\/015008","article-title":"A portable diagnostic device for cardiac magnetic field mapping","volume":"3","author":"Mooney","year":"2017","journal-title":"Biomed. Phys. Eng. Express"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e038804","DOI":"10.1136\/bmjopen-2020-038804","article-title":"MAGNETO cardiography parameters to predict future sudden cardiac death (MAGNETO-SCD) or ventricular events from implantable cardioverter defibrillators: Study protocol, design and rationale","volume":"10","author":"Lachlan","year":"2020","journal-title":"BMJ Open"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.hrthm.2022.12.020","article-title":"Feasibility of novel unshielded portable magnetocardiography: Insights from the prospective multicenter MAGNETO-SCD trial","volume":"20","author":"Lachlan","year":"2023","journal-title":"Heart Rhythm"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e014998","DOI":"10.1161\/CIRCEP.126.014998","article-title":"Discovery of Novel Magnetocardiography Parameters Predicting Future ICD Therapies: Insights From the Magneto-SCD Study","volume":"19","author":"Lachlan","year":"2026","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Lachlan, T., He, H., Miller, A., Chandan, N., Siddiqui, S., Beadle, R., Wilson, D., Petkar, S., Kimani, P.K., and Ng, G.A. (2026). MAGNETOcardiography Parameters to Predict Sudden Cardiac Death (MAGNETO-SCD) or Ventricular Events From Implantable Cardioverter Defibrillators. JACC Clin. Electrophysiol., in press.","DOI":"10.1016\/j.jacep.2026.05.020"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1080\/01621459.1999.10474144","article-title":"A proportional hazards model for the subdistribution of a competing risk","volume":"94","author":"Fine","year":"1999","journal-title":"J. Am. Stat. Assoc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1016\/j.jacep.2023.07.005","article-title":"Alert Transmissions From Remote Monitoring of Patients With Cardiac Implantable Devices","volume":"9","author":"Pyka","year":"2023","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2940","DOI":"10.1093\/eurheartj\/ehz260","article-title":"Arrhythmic risk stratification in post-myocardial infarction patients with preserved ejection fraction: The PRESERVE EF study","volume":"40","author":"Gatzoulis","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1056\/NEJMoa1608029","article-title":"Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure","volume":"375","author":"Thune","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.jchf.2016.09.017","article-title":"Late Gadolinium Enhancement and the Risk for Ventricular Arrhythmias or Sudden Death in Dilated Cardiomyopathy: Systematic Review and Meta-Analysis","volume":"5","author":"Anguera","year":"2017","journal-title":"JACC Heart Fail."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2106","DOI":"10.1161\/CIRCULATIONAHA.116.026910","article-title":"Association Between Midwall Late Gadolinium Enhancement and Sudden Cardiac Death in Patients With Dilated Cardiomyopathy and Mild and Moderate Left Ventricular Systolic Dysfunction","volume":"135","author":"Halliday","year":"2017","journal-title":"Circulation"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e003648","DOI":"10.1136\/openhrt-2025-003648","article-title":"Wearable cardioverter defibrillator for transient arrhythmic risk and sudden cardiac death prevention: A systematic review and updated meta-analysis","volume":"12","author":"Matteucci","year":"2025","journal-title":"Open Heart"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e002787","DOI":"10.1136\/openhrt-2024-002787","article-title":"Appropriate use of wearable defibrillators with multiparametric evaluation to avoid unnecessary defibrillator implantation","volume":"11","author":"Matteucci","year":"2024","journal-title":"Open Heart"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/j.repc.2023.01.023","article-title":"Treatment with gentamicin-impregnated collagen sponges in reducing infection of implantable cardiac devices: 10-year analysis with propensity score matching","volume":"42","author":"Matteucci","year":"2023","journal-title":"Rev. Port. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Matteucci, A., Pignalberi, C., Pandozi, C., Magris, B., Meo, A., Russo, M., Galeazzi, M., Schiaffini, G., Aquilani, S., and Di Fusco, S.A. (2024). Prevention and Risk Assessment of Cardiac Device Infections in Clinical Practice. J. Clin. Med., 13.","DOI":"10.3390\/jcm13092707"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/6985\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:01:43Z","timestamp":1788958903000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/6985"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":24,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15186985"],"URL":"https:\/\/doi.org\/10.3390\/jcm15186985","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]}}}