Early Implantation of Primary Prevention Implantable Cardioverter Defibrillators for Patients with Newly Diagnosed Severe Nonischemic Cardiomyopathy

Abstract

Early appropriate therapy, particularly for ventricular fibrillation, is infrequent for patients with very severe NICM who have ICDs implanted within 6 months of diagnosis. The majority of these patients would not qualify for an ICD at 12 months postinsertion. In the absence of a multimodality risk score, early ICD insertion should only be considered in selected cases (presence of LGE and NSVT). Wearable cardioverter defibrillators may have a role as a bridge to ICD decision.

Absence of late gadolinium enhancement on cardiac magnetic resonance imaging in ventricular fibrillation and nonischemic cardiomyopathy

“…However, LVEF remains the most widely used risk stratification tool in the primary prevention setting, owing to five large randomized trials demonstrating survival benefit from ICDs where severely reduced LVEF was a key trial inclusion criteria. While many patients may have significant improvements in LVEF over a short period, often mitigating their SCD risk, others with milder systolic dysfunction but significant scar may be overlooked. In fact, the majority of NICM patients with VF or SMVT in our cohort would not have received an ICD by primary prevention criteria using LVEF alone.…”