Arrhythmic Risk Following Recovery of Left Ventricular Ejection Fraction in Patients with Primary Prevention ICD

Berthelot-Richer, Maxime; Bonenfant, Francis; Clavel, Marie‐Annick; Farand, Paul; Philippon, François; Ayala‐Paredes, Felix; Essadiqi, Btissama; Badra-Verdu, Mariano; Roux, Jean‐François

doi:10.1111/pace.12868

Cited by 7 publications

(11 citation statements)

References 20 publications

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“…These patients would have benefited from waiting for completion of reverse remodeling. Accordingly, ICD recipients may improve in LVEF after ICD implantation and subsequently show a very low arrhythmic risk 8, 15, 16. ICD implantation in these patients occurred too early and left the patients only at risk for device‐related complications.…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, ICD recipients may improve in LVEF after ICD implantation and subsequently show a very low arrhythmic risk. 8,15,16 ICD implantation in these patients occurred too early and left the patients only at risk for device-related complications. According to our data, when re-evaluating LVEF after 3 months, we propose 3 indications for prolongation of reverse remodeling period: (1) LVEF 30% to 35%; (2) D LVEF ≥5%; and (3) insufficient optimization of medical dosages (especially MRA).…”

Section: Reverse Remodelingmentioning

confidence: 99%

“…6,7 Moreover, even in patients already implanted with an ICD according to guidelines, LVEF may improve with consecutively reduced arrhythmic risk. 8 The wearable cardioverter/defibrillator (WCD; LifeVest, ZOLL, Pittsburgh, USA) was introduced for temporary prevention of sudden cardiac death (SCD) in selected populations and provides secured time for sophisticated risk stratification. 9 In the early phase after diagnosis of heart failure with reduced LVEF, titration of heart failure medication is cumbersome, but, however, crucial for optimal elicitation of LVEF recovery and therefore may take time.…”

mentioning

confidence: 99%

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Avoiding Untimely Implantable Cardioverter/Defibrillator Implantation by Intensified Heart Failure Therapy Optimization Supported by the Wearable Cardioverter/Defibrillator—The PROLONG Study

Duncker

König

Hohmann

et al. 2017

JAHA

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BackgroundOptimal timing of implantation of an implantable cardioverter/defibrillator (ICD) after newly diagnosed heart failure is unclear given that late reverse remodelling may occur. We aimed to analyze left ventricular ejection fraction (LVEF) after diagnosis of an LVEF ≤35% during optimization of heart failure drug therapy.Methods and ResultsOne hundred fifty‐six patients with newly diagnosed LVEF ≤35% receiving a wearable cardioverter/defibrillator (WCD) were analyzed. WCD was prescribed for 3 months until first re‐evaluation. Indications for prolongation of WCD wearing period instead of ICD implantation were: (1) LVEF at 3‐month visit 30% to 35%; (2) increase in LVEF of ≥5% compared to the last visit; and (3) nonoptimized heart failure medication. Mean LVEF was 24±7% at diagnosis and 39±11% at last follow‐up (mean, 12±10 months). Whereas 88 patients presented a primary preventive ICD indication (LVEF ≤35%) at 3‐month follow‐up, only 58 showed a persistent primary preventive ICD indication at last follow‐up. This delayed improvement in LVEF was related to nonischemic origin of cardiomyopathy, New York Heart Association functional class at baseline, heart rate, better LVEF after 3 months, and higher dosages of mineralocorticoid receptor antagonist. Twelve appropriate WCD shocks for ventricular tachycardia/ventricular fibrillation occurred in 11 patients. Two patients suffered from ventricular tachycardia/ventricular fibrillation beyond 3 months after diagnosis.ConclusionsA relevant proportion of patients with newly diagnosed heart failure shows recovery of LVEF >35% beyond 3 months after initiation of heart failure therapy. To avoid untimely ICD implantation, prolongation of WCD period should be considered in these patients to prevent sudden cardiac death while allowing left ventricular reverse remodeling during intensified drug therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Reverse Remodelingmentioning

confidence: 99%

mentioning

confidence: 99%

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Avoiding Untimely Implantable Cardioverter/Defibrillator Implantation by Intensified Heart Failure Therapy Optimization Supported by the Wearable Cardioverter/Defibrillator—The PROLONG Study

Duncker

König

Hohmann

et al. 2017

JAHA

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“…In addition to LVEF alone, we also looked at LVEF recovery that we defined as EF > 35% at the time of generator replacement and an increase of ≥10% from baseline. An LVEF recovery threshold of 35% was chosen based on current recommendations for primary prevention ICD implantation 1,19 . We also added an arbitrary ≥ 10% LVEF improvement from baseline.…”

Section: Discussionmentioning

confidence: 99%

“…An LVEF recovery threshold of 35% was chosen based on current recommendations for primary prevention ICD implantation. 1,19 We also added an arbitrary ≥ 10% LVEF improvement from baseline. It is well-known that patients with cardiomyopathy experience improvement in their LVEF after guideline-medical therapy.…”

Section: Discussionmentioning

confidence: 99%

Predictors of appropriate shock after generator replacement in patients with an implantable cardioverter defibrillator

Arcinas

Chew

Seifer

et al. 2021

Pacing Clinical Electrophis

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Background Implantable cardioverter defibrillators (ICDs) are indicated for the primary prevention of sudden cardiac death in patients with reduced left ventricular ejection fraction (LVEF). The ongoing risk/benefit profile of an ICD at generator replacement is unknown. This study aimed to identify predictors of appropriate ICD shocks and therapies after first ICD generator replacement, and its procedure‐related complications. Methods We conducted a multicenter, retrospective cohort study including patients with primary prevention ICDs who underwent generator replacement between April 2005 and July 2015 at three Canadian centers. The primary and secondary outcomes were appropriate ICD shock and any appropriate ICD therapy, respectively. Procedure‐related complication rates were also reported. Results Of the 219 patients in the cohort, 61 (28%) experienced an appropriate shock while 40 (18%) experienced appropriate antitachycardia pacing over a median follow up of 2.2 years. Independent predictors of appropriate ICD shocks included: LVEF at time of replacement (adjusted odds ratio [OR] 0.4 per 10% increase in LVEF, P < .001), a history of appropriate ICD shocks prior to replacement (OR 4.9, P < .001), and a history of inappropriate ICD shocks (OR 4.2, 95%, P < .002). Similar predictors were identified for the secondary outcome of any appropriate ICD therapy. Device‐related complications were reported in 25 (11%) patients, with 1 (0.5%) resulting in death, 14 (6.3%) requiring site re‐operation, and 6 (2.7%) requiring cardiac surgical management. Conclusion Not all primary prevention ICD patients undergoing generator replacement will require appropriate device therapies afterwards. Generator replacement is associated with several risks that should be weighed against its anticipated benefit. A comprehensive assessment of the risk‐benefit profile of patients undergoing generator replacement is warranted.

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Heart failure with recovered ejection fraction and the utility of defibrillator therapy: a review

et al. 2021

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Heart failure with recovered ejection fraction (HFrecEF) involves those who have previously had reduced cardiac function that has subsequently improved. However, there is not a single definition of this phenomenon and recovery of cardiac function in terms of left ventricular ejection fraction (LVEF) itself does not necessarily correlate with remission from the detrimental physiology of heart failure (HF) and its consequences. There is also the question of the utility of defibrillators in these patients, and whether they should be replaced at the time of battery depletion. To address this, several studies have shown specific predictors of ensuing LVEF recovery, including patient demographics, co‐morbidities, and medication use, as well as predictors of ventricular arrhythmias (VA) following LVEF recovery. Recent studies have also shown novel imaging parameters that may aid in predicting which patients would have a higher risk of these arrhythmias. Additional data describe a small, yet appreciable risk of VA, in addition to appropriate shocks as well. In this review, we describe predictors of LVEF recovery, carefully analyse and characterize the continued risk for VA and appropriate shocks following LVEF recovery, and explore additional novel modalities that may aid in decision‐making.

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Arrhythmic Risk Following Recovery of Left Ventricular Ejection Fraction in Patients with Primary Prevention ICD

Cited by 7 publications

References 20 publications

Avoiding Untimely Implantable Cardioverter/Defibrillator Implantation by Intensified Heart Failure Therapy Optimization Supported by the Wearable Cardioverter/Defibrillator—The PROLONG Study

Avoiding Untimely Implantable Cardioverter/Defibrillator Implantation by Intensified Heart Failure Therapy Optimization Supported by the Wearable Cardioverter/Defibrillator—The PROLONG Study

Predictors of appropriate shock after generator replacement in patients with an implantable cardioverter defibrillator

Heart failure with recovered ejection fraction and the utility of defibrillator therapy: a review

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