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Should Primary Prevention ICDs Still Be Placed in Patients with Non-ischemic Cardiomyopathy? A Review of the Evidence

  • Harsha V. Ganga
  • Abhishek Maan
  • E. Kevin Heist
Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Invasive Electrophysiology and Pacing

Abstract

Purpose of Review

Recent evidence has suggested that implantable defibrillator (ICD) in non-ischemic cardiomyopathy (NICM) may not offer mortality benefit in the presence of guideline-directed medical therapy (GDMT) and cardiac resynchronization therapy (CRT).

Recent Findings

Despite significant benefits of GDMT and CRT, current evidence is derived from ICD trials that rely predominantly on reduced left ventricular ejection fraction alone (LVEF). The majority of patients with sudden cardiac death (SCD) have LVEF > 30% indicating that LVEF by itself is an inadequate predictor of SCD. The Danish study to assess the efficacy of ICD in patients with non-ischemic systolic heart failure on mortality (DANISH) highlights the importance of better risk stratifying NICM patients for ICD implantation.

Summary

Assessment of life expectancy, comorbidities, presence of advanced heart failure, etiology of NICM, and the presence of myocardial fibrosis can help risk stratify ICD beyond LVEF. Genetics and biomarkers can be of further assistance in risk stratification.

Keywords

Implantable cardioverter defibrillator Non-ischemic cardiomyopathy Primary prevention Risk stratification 

Notes

Compliance with Ethical Standards

Conflict of Interest

Harsha V. Ganga declares that he has no conflict of interest.

Abhishek Maan: Medtronic (research grant), Biotronik (research grant), Biosense-Webster (research grant).

E. Kevin Heist: Boston Scientific (consultant, research grant), Biotronik (consultant, research grant), Medtronic (consultant), Pfizer (consultant), St. Jude Medical (consultant, research grant).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Harsha V. Ganga
    • 1
  • Abhishek Maan
    • 1
  • E. Kevin Heist
    • 2
  1. 1.Division of Cardiology, Rhode Island HospitalWarren Alpert Medical School of Brown UniversityProvidenceUSA
  2. 2.Cardiac Arrhythmia ServiceMassachusetts General HospitalBostonUSA

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