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Implantable cardioverter defibrillator therapy activation for high risk patients with relatively well preserved left

Konstantinos A Gatzoulis1, Dimitris Tsiachris, Polichronis Dilaveris

  • 1First Cardiology Department, University of Athens Medical School, Hippokration Hospital, Athens, Greece. kgatzoul@med.uoa.gr

International Journal of Cardiology
|April 27, 2012
PubMed

Insights

Implantable cardioverter-defibrillator (ICD) therapy may benefit heart failure patients with reduced ejection fraction. However, patients with LVEF ≤ 35% experienced higher mortality, suggesting careful risk stratification is needed.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Preventive Medicine

Background:

  • Current guidelines recommend implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden cardiac death in patients with left ventricular ejection fraction (LVEF) ≤ 35%.
  • This study investigates mortality and ICD activation rates in patients stratified by LVEF cut-off values.

Purpose of the Study:

  • To compare mortality and ICD activation rates in patients receiving ICDs, specifically examining the impact of LVEF ≤ 35% versus preserved LVEF.
  • To evaluate the effectiveness of ICDs in primary prevention of sudden cardiac death across different LVEF groups.

Main Methods:

  • A cohort of 495 ICD recipients was followed for a mean of 41.1 months.
  • Patients were categorized based on LVEF ≤ 35% and LVEF >35%, with primary prevention defined by guideline criteria or inducible ventricular arrhythmia.
  • Mortality and appropriate device therapy rates were compared between groups.

Main Results:

  • Patients with LVEF ≤ 35% had significantly higher total mortality (18% vs. 11%) and cardiac death (15.4% vs. 5.5%) compared to those with preserved LVEF.
  • No significant difference in appropriate ICD therapy incidence was observed between LVEF groups (56.9% vs. 65.8%).
  • Advanced New York Heart Association stage was a predictor of both total and cardiac mortality.

Conclusions:

  • ICD therapy may offer protection against arrhythmic events in heart failure patients, particularly when guided by electrophysiology-based risk stratification.
  • The findings suggest that while ICDs provide appropriate therapy, LVEF ≤ 35% is associated with increased overall mortality, necessitating tailored risk assessment.
Abstract

Keywords:
Implantable cardioverter defibrillatorLeft ventricular ejection fractionProgrammed ventricular stimulation

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