Continuation of ICD treatment at the time of device exchange without adequate treatment?

Abstract

Due to improved treatment of heart failure, patients are older and have more comorbidities at the time of an elective device exchange. This leads to higher rates of complications and represents an opportunity for re-evaluation of the implantable cardioverter defibrillator (ICD) treatment. This article reviews the current literature regarding the indications for continued ICD therapy and device exchange in patients who have never received adequate treatment through the ICD. Patients with primarily prophylactic indications, who have not received adequate treatment and have shown significant improvement in the left ventricular ejection fraction (LVEF) >35%, have asignificantly lower risk of ventricular arrythmia (VA) after device exchange. Although further ventricular events can occur in these patients, the continuation of ICD treatment should be individually discussed in cases of high age and increased comorbidities. In female patients with anon-ischemic cardiac myopathy and an almost normalized LVEF, mostly during cardiac resynchronization therapy (CRT), a discontinuation of ICD treatment or downgrading to CRT with pacemaker (CRT-P) treatment should be discussed. At the time of an elective device exchange for primarily prophylactic indications, the possibility to discontinue ICD treatment can be discussed with patients who have not experienced adequate treatment. Additional factors, such as LVEF, age, sex and comorbidities of the patient should be taken into consideration in order to make an individualized decision. As prospective randomized studies are lacking, it is not possible to give generally valid recommendations.