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The Benefit of Prophylactic Implantable Cardioverter Defibrillator Implantation in Asymptomatic Heart Failure

Anne-Lotte C J van der Lingen1, Stefan A J Timmer1, Laurens J H Allaart1

  • 1Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiology, Amsterdam, the Netherlands.

The American Journal of Cardiology
|July 5, 2019
PubMed

Insights

Asymptomatic heart failure patients (NYHA class I) with reduced ejection fraction receiving prophylactic ICDs experienced a higher rate of appropriate device therapy (ADT) than those with more severe symptoms (NYHA class II-III). These findings support ICD implantation in asymptomatic patients.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Guidelines for prophylactic implantable cardioverter defibrillator (ICD) implantation in asymptomatic heart failure patients with reduced left ventricular ejection fraction (LVEF) are inconsistent.
  • Limited evidence exists regarding the risk of appropriate device therapy (ADT) and mortality in New York Heart Association (NYHA) class I patients.

Purpose of the Study:

  • To evaluate the incidence of ADT and mortality in NYHA class I patients undergoing primary prevention ICD implantation with LVEF ≤35%.
  • To compare ADT and mortality rates between NYHA class I and NYHA class II-III patients receiving prophylactic ICDs.

Main Methods:

  • Retrospective cohort study of 572 patients with LVEF ≤35% who received a prophylactic ICD or CRT-D.
  • Cox regression analysis was used to compare ADT and mortality between NYHA class I and NYHA class II-III patients.
  • Follow-up duration was 4.1 ± 2.4 years.

Main Results:

  • NYHA class I patients had a significantly higher incidence of ADT (33%) compared to NYHA class II-III patients (20%) (HR 1.5, p=0.03).
  • No significant difference in mortality was observed between the groups (HR 0.70, p=0.10).
  • NYHA class was identified as the strongest independent predictor of ADT in multivariable analyses.

Conclusions:

  • Primary prevention ICD patients in NYHA class I exhibit a higher incidence of ADT than those in NYHA class II-III.
  • These findings suggest that asymptomatic NYHA class I patients with LVEF ≤35% may benefit from ICD therapy.
  • Exclusion of NYHA class I patients from potentially life-saving ICD therapy should be reconsidered.

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