As genetic testing for arrhythmogenic right ventricular cardiomyopathy has subtle complexities, the decision to proceed with family screening is facilitated by informed genetic counseling to discuss the cost of test- ing, the potential lack of a single gene as the determinant for disease expression, psychological implications of uncertain disease progression, and implications for lifestyle modification, screening, and potential treatment. 2. Cardiac MRI provides high-quality assess- ment of ventricular function, size, regional wall motion abnormalities, and extent of scar and fibrosis (late gadolinium enhancement) that are seen in 30% to 95% of patients with the clini- cal diagnosis of arrhythmogenic right ventricu- Cardiac MRI detects biventricular involvement in 34% to 56% of patients, with isolated LV involve- ment noted in 4% to 9% of patients.S7.3-37 S7.3-40 Cardiac MRI should include assessment of late gadolinium enhancement with quantification of fibrosis. Application of the 2010 Task Force Criteria to cardiac MRI criteria for diagnosis of arrhythmogenic right ventricular cardiomyopa- thy has improved the specificity of this test.S7.3- Electrocardiographic and Holter findings precede detectable cardiac MRI abnormalities in arrhythmogenic right ventricular cardiomyopa- thy mutation-positive individuals, with only 4% of patients with normal electrocardiographic and Holter results having cardiac MRI abnormalities, Recommendations for Arrhythmogenic Right Ventricular Cardiomyopathy (Continued) COR LOE Recommendations CLINICAL STATEMENTS AND GUIDELINES suggesting that evaluation of cardiac structure and function using cardiac MRI may be unnecessary in mutation-positive individuals who do not have The presence of both electrocardiographic abnormalities and abnor- mal cardiac MRI findings may identify patients at an increased risk for developing sustained Areas of scar identified on cardiac MRI have correlated with the location of VT sub- strate identified by endocardial and epicardial During early stages of disease, a baseline cardiac MRI may provide useful informa- tion along with electrocardiographic and rhythm abnormalities to monitor disease progression over time. 