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[Implantable cardioverter-defibrillator in patients with chronic heart failure]

Naoki Matsuda1

  • 1Department of Cardiology, Tokyo Women's Medical University.

Nihon Rinsho. Japanese Journal of Clinical Medicine
|May 13, 2006
PubMed

Insights

Implantable cardioverter-defibrillators (ICDs) reduce sudden cardiac death (SCD) in heart failure patients, but their effectiveness is modest in advanced stages. Combined therapies may be necessary for better outcomes.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Context:

  • Sudden cardiac death (SCD) is a significant cause of mortality in chronic heart failure (CHF) patients.
  • Implantable cardioverter-defibrillators (ICDs) are established for secondary prevention of SCD in heart failure.
  • Primary prevention with ICDs is increasingly considered for patients with left ventricular (LV) systolic dysfunction.

Purpose:

  • To review the efficacy and indications of ICDs for sudden cardiac death prevention in heart failure patients.
  • To discuss the role of ICDs in primary versus secondary prevention of SCD.
  • To explore alternative and combined therapies for advanced heart failure.

Summary:

  • ICDs effectively reduce mortality and SCD incidence in heart failure, particularly for secondary prevention.
  • Evidence supports ICD use for primary prevention in LV systolic dysfunction, though efficacy may be modest in advanced heart failure.
  • Individualized combined therapies (e.g., ICD plus amiodarone or cardiac resynchronization therapy) are crucial for advanced cases.
  • The applicability of ICDs in specific populations (e.g., Japanese patients in MADIT II and SCD-HeFT trials) requires further consideration due to lower SCD incidence.

Impact:

  • ICD therapy significantly improves survival rates in eligible heart failure patients.
  • The findings highlight the need for personalized treatment strategies in advanced heart failure.
  • This review informs clinical decision-making regarding ICD implantation for SCD prevention.

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