Assessment of ICD eligibility in non-ischaemic cardiomyopathy patients: a position statement by the Task Force of the...

Area of Science:

• Cardiology
• Electrophysiology

Background:

• International guidelines recommend implantable cardioverter-defibrillators (ICDs) for non-ischaemic cardiomyopathy (NICM) patients with left ventricular ejection fraction (LVEF) < 35%.
• Current recommendations do not fully account for all risk factors influencing mortality in NICM.

Purpose of the Study:

• To propose refined recommendations for ICD implantation in NICM patients.
• To incorporate additional risk parameters for both arrhythmic and non-arrhythmic death.

Main Methods:

• Consideration of late gadolinium enhancement on cardiac MRI for arrhythmic risk assessment.
• Inclusion of genetic testing for high-risk variants to evaluate arrhythmic risk.
• Assessment of non-arrhythmic mortality risk using age, comorbidities, and sex.
• Evaluation of risk modifiers like concomitant arrhythmias and resynchronisation therapy.

Main Results:

• The proposed approach allows for more nuanced risk stratification in NICM patients.
• It may lead to withholding ICD implantation in patients with low arrhythmic risk but high non-arrhythmic mortality risk.
• No definitive cut-off values have been established yet.

Conclusions:

• Refining ICD implantation guidelines for NICM is crucial.
• Integrating comprehensive risk assessment, including imaging, genetics, and clinical factors, improves patient selection.
• Personalized risk assessment can optimize treatment decisions and resource allocation.