Comparable Efficacy in Ischemic and Non-Ischemic ICD Recipients for the Primary Prevention of Sudden Cardiac Death.

Andreea Maria Ursaru,Nicolae Dan Tesloianu,Irina Iuliana Costache,Antoniu Octavian Petris

doi:10.3390/biomedicines9111595

Abstract

(1) Background: In patients suffering from heart failure, the main causes of death are either hemodynamic failure, or ventricular arrhythmias. The only tool to significantly reduce arrhythmic sudden death is the implantable cardioverter defibrillator (ICD), but not all patients benefit to the same extent from these devices. (2) Methods: The primary outcome of this single-center study was defined as cardiovascular death in patients with ischemic and non-ischemic heart failure who have benefited from ICD therapy. The secondary outcomes were death from any cause, sudden cardiac death, ICD-related therapies (appropriate antitachycardia pacing or shock therapy for ventricular tachycardia or fibrillation) and recurrences of ventricular tachyarrhythmias. (3) Results: A total of 403 consecutive ICD recipients—symptomatic heart failure patients with ICD for the primary prevention of sudden cardiac death—were included retrospectively: 59% ischemic cardiomyopathy (ICMP) and 41% non-ischemic cardiomyopathy (NICMP) patients. Within a median follow-up period of 36 months, the incidence of cardiovascular mortality was not significantly different in patients with NICMP and ICMP: the primary outcome had occurred in 9 patients (5.4%) in the NICMP group and in 14 patients (5.9%) in the ICMP group (hazard ratio 1; 95% confidence interval (CI) 0.45 to 2.28; p = 0.97). All-cause mortality occurred in 14 of 166 patients (8.4%) in the NICMP group and 18 of 237 patients (7.6%) in the ICMP group. Sudden cardiac death occurred in two patients (1.2%) in the NICMP group and in four patients (1.7%) in the ICMP group (hazard ratio 0.71; 95% CI, 0.13 to 3.88; p = 0.69). The rate of appropriate device therapies was comparable in both groups. (4) Conclusions: In this study, ICD implantation for primary prevention of sudden cardiac death in patients with symptomatic systolic heart failure was associated with similar rates of cardiovascular and all-cause mortality in patients with ischemic heart disease, and in patients with heart failure from other causes. NICMP and ICMP showed comparable rates of recurrent ventricular tachyarrhythmias and appropriate ICD therapies.

Highlights

In patients with heart failure and reduced left ventricular ejection fraction (LVEF < 35%), there is an increased risk of sudden cardiac death (SCD) due to ventricular arrhythmias, with the highest risk in those who survived an episode of ventricular fibrillation (VF) or sustained ventricular tachycardia (VT) [1]
(4) Conclusions: In this study, implantable cardioverter defibrillator (ICD) implantation for primary prevention of sudden cardiac death in patients with symptomatic systolic heart failure was associated with similar rates of cardiovascular and all-cause mortality in patients with ischemic heart disease, and in patients with heart failure from other causes
In the American Heart Association Guidelines, on the other hand, ICD implantation for primary prevention of SCD in patients with symptomatic systolic heart failure is a class 1A recommendation, with no differentiation between patients with ischemic and non-ischemic cardiomyopathy [4]. This difference arises from the trials on which the guidelines are based: the American Heart Association Guidelines refer to the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), the 2016 European Guidelines consider the Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE), while the latest European Society of Cardiology (ESC) Guidelines version grounds its recommendations on the DANISH study

Summary

Introduction

In patients with heart failure and reduced left ventricular ejection fraction (LVEF < 35%), there is an increased risk of sudden cardiac death (SCD) due to ventricular arrhythmias, with the highest risk in those who survived an episode of ventricular fibrillation (VF) or sustained ventricular tachycardia (VT) [1]. ESC Heart Failure Guidelines, primary prevention of SCD in patients with symptomatic systolic non-ischemic heart failure was downgraded from a 1B recommendation class. In the American Heart Association Guidelines, on the other hand, ICD implantation for primary prevention of SCD in patients with symptomatic systolic heart failure is a class 1A recommendation, with no differentiation between patients with ischemic and non-ischemic cardiomyopathy [4]. This difference arises from the trials on which the guidelines are based: the American Heart Association Guidelines refer to the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), the 2016 European Guidelines consider the Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation

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