Current Status of Implantable Cardioverter-Defibrillators (ICDs)/Cardiac Resynchronization Therapy With...

Area of Science:

• Cardiology
• Electrophysiology
• Public Health

Background:

• Non-ischemic etiology is the predominant cause for implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy with defibrillators (CRT-D) recipients in Japan.
• This prevalence is higher in Japan compared to the United States and European countries.
• Concerns exist regarding primary prevention ICD/CRT-D implantation for non-ischemic systolic heart failure patients on guideline-directed medical therapy (GDMT).

Purpose of the Study:

• To evaluate the effectiveness of ICD/CRT-D therapy in reducing all-cause and sudden cardiac death in non-ischemic heart failure patients.
• To compare the cumulative incidence of appropriate ICD/CRT-D therapy between non-ischemic and ischemic patients.
• To assess the impact of primary prevention ICD/CRT-D therapy on all-cause mortality risk.

Main Methods:

• Analysis of two cohort studies in Japan examining ICD/CRT-D therapy incidence.
• Review of published cohort studies from the United States, Europe, and Japan on primary prevention ICD/CRT-D recipients.
• Comparison of all-cause death risk between ICD/CRT-D recipients and non-recipients.

Main Results:

• ICD/CRT-D therapy is likely effective in reducing the relationship between all-cause death and sudden cardiac death.
• Cumulative incidence of appropriate ICD/CRT-D therapy is higher in non-ischemic patients compared to ischemic patients.
• Primary prevention ICD/CRT-D therapy significantly decreases the risk of all-cause death.

Conclusions:

• ICD/CRT-D therapy demonstrates significant benefit for primary prevention in non-ischemic systolic heart failure.
• Despite proven efficacy, ICD/CRT-D utilization in Japan remains the lowest among G7 countries.
• Governmental recognition and educational initiatives are crucial to increase adoption and prevent future healthcare burdens from out-of-hospital cardiac arrest.