To the Editor—Should an improvement in left ventricular systolic function preclude ICD generator replacement?

Abstract

Schliamser et al 1 Schliamser J.E. Kadish A.H. Subacius H. et al. DEFINITE Investigators. Significance of follow-up left ventricular ejection fraction measurements in the Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation trial (DEFINITE). Heart Rhythm. 2013; 10: 838-846 Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar evaluated the effect of left ventricular ejection fraction (LVEF) change on outcome in the DEFINITE (Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation) trial and concluded that LVEF improvement during follow-up was associated with improved survival but not with a significant decrease in appropriate shocks, thus supporting the idea that these patients still derive an important benefit from the implantable cardioverter-defibrillator (ICD). However, despite the novelty of the study, some of their findings may be questionable. Reply to the Editor—Should an Improvement in Left Ventricular Systolic Function Preclude ICD Generator Replacement?Heart RhythmVol. 10Issue 9PreviewIn their Letter to the Editor, Barra and Agarwal present a case supporting an alternative recommendation for the clinical implications of the post hoc analysis of change in left ventricular ejection fraction (LVEF) in the DEFINITE trial.1 Although they eloquently review many of the limitations related to the standards of device programming that existed at the time of the DEFINITE trial, post hoc analyses should be interpreted cautiously and have many caveats. They are rarely, if ever, incorporated in guidelines. Full-Text PDF