Left Ventricular Mechanical Reverse Remodelling Not Followed by Electrical Reverse Remodelling: A Case Report.

Area of Science:

• Cardiology
• Electrophysiology
• Cardiovascular Medicine

Background:

• Implantable cardioverter-defibrillators (ICDs) are crucial for primary prevention of sudden cardiac death in patients with severely reduced left ventricular ejection fraction (LVEF).
• Therapeutic interventions can lead to significant improvement, even normalization, of LVEF over time in some individuals.

Observation:

• A patient with idiopathic dilated cardiomyopathy achieved normalized LVEF following pharmacological therapy.
• Despite LVEF normalization, the patient experienced life-threatening ventricular fibrillation, successfully terminated by the ICD.

Findings:

• This case highlights that even with LVEF recovery, the underlying myocardial substrate may persist, posing a risk for ventricular arrhythmias.
• The patient's experience underscores the continued need for ICDs in select cases, irrespective of initial LVEF criteria.

Implications:

• The findings prompt a re-evaluation of device management strategies in patients with improved LVEF, including the necessity of battery replacement for ICDs.
• Understanding left ventricular reverse remodeling and arrhythmogenesis is critical for optimizing patient care and device therapy.