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Left Ventricular Ejection Fraction Improvement and Ventricular Arrhythmia Risk in Patients With Heart Failure

Toshihiro Nakamura1, Kohei Ishibashi1, Nobuhiko Ueda1

  • 1Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center.

Circulation Journal : Official Journal of the Japanese Circulation Society
|December 10, 2025
PubMed

Insights

Implantable cardioverter defibrillators (ICDs) help prevent sudden cardiac death. Even with improved heart function (LVEF recovery), some patients may still need ICD therapy, indicating personalized management is key.

Area of Science:

  • Cardiology
  • Electrophysiology

Background:

  • Implantable cardioverter defibrillators (ICDs) are crucial for preventing sudden cardiac death in heart failure patients.
  • The efficacy of ICDs after recovery of left ventricular ejection fraction (LVEF) remains uncertain.

Purpose of the Study:

  • To evaluate the long-term outcomes of primary prevention ICD therapy in patients who experience LVEF recovery.

Main Methods:

  • Retrospective analysis of 118 patients receiving primary prevention ICDs between 2013 and 2022.
  • Patients were categorized based on LVEF improvement (impEF: LVEF >35%) versus persistently low LVEF.

Main Results:

  • 34% of patients (40/118) achieved improved LVEF (impEF).
  • The impEF group experienced significantly less appropriate ICD therapy (P=0.008) over 4.4 years.
  • However, 4 impEF patients required antitachycardia pacing; no patient with LVEF ≥40% received therapy.

Conclusions:

  • LVEF recovery significantly reduces ventricular arrhythmia risk in ICD patients.
  • Risk is not eliminated, underscoring the need for individualized ICD management strategies.
Abstract

Keywords:
Guideline-recommended medical therapyHeart failure with reduced ejection fractionImplantable cardioverter defibrillatorLeft ventricular ejection fractionVentricular arrhythmia

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