The impact of implantable cardioverter defibrillator on the prognosis of nonischemic dilated cardiomyopathy patients compared with standard medical treatments

Abstract

Background: Patients with nonischemic dilated cardiomyopathy (DCM) are susceptible to arrhythmias and implantable cardioverter defibrillator (ICD) in addition to medical treatments may help prevent sudden cardiac death (SCD) and improve survival in this population.Hypothesis: We aim to investigate the impact of ICD insertion on survival and prognosis of patients with nonischemic DCM.Methods: We retrospectively analyzed data from patients with nonischemic DCM treated with medical therapy with or without ICD who referred to our hospital from January 2020 to November 2021. Patients were divided based on the treatment that they had received into two equal groups. Different variables including demographic features, comorbidities, medical treatments, hospitalization rate, function class, and left ventricular ejection fraction before and after treatments were investigated in this study. In addition, variables in survival including overall survival (OS) and SCD were compared between the two groups.Results: A total of 120 patients were investigated in this study. Mean ± SD of age and follow-up time of patients were 64.0 ± 12.7 years old and 61.2 ± 15.9 months, respectively. Ten (16.7%) patients with medical therapy, and seven (11.7%) patients with ICD and medical therapy died during the follow-up period (p = 0.25). However, the two groups had a significant difference regarding SCD (11.7% vs. 1.7%, p = 0.02). Conclusion:In patients with nonischemic DCM who had undergone ICD insertion in addition to standard medical treatments, SCD was significantly reduced compared with patients receiving just medical treatments. OS had no significant difference between our two studied groups.

Impact of implantable cardioverter defibrillator on survival in patients with non‐ischemic dilated cardiomyopathy

“… 3 Thus, one of the current issues is the prevention of nonarrhythmic death. In their study of nonischemic DCM, 1 the overall survival was not affected by ICD implantation. Could the authors attempt to evaluate the cause of death other than sudden cardiac death and discuss how to prevent such a death?…”

“…To the Editor, The prognostic impact of implantable cardioverter defibrillator (ICD) therapy in patients with nonischemic dilated cardiomyopathy (DCM) has been of great interest. Omran 1 and colleagues compared clinical outcomes between ICD therapy and medical therapy alone without ICD in patients with nonischemic DCM. In their study, the rate of sudden cardiac death was lower in patients receiving ICD, whereas the overall survival did not differ between the two therapeutic strategies.…”

“…Another concern is the protocol of their study. The baseline characteristics of the two groups (i.e., ICD group vs. medication group) were not statistically matched, 1 and the inclusion/exclusion criteria should be more clearly stated. The clinical impact of ICD therapy is not similar between primary prevention and secondary prevention, which should be more clearly stated.…”

Response: Impact of implantable cardioverter defibrillator on survival in patients with nonischemic dilated cardiomyopathy

“…In our study entitled “The impact of implantable cardioverter defibrillator on the prognosis of nonischemic dilated cardiomyopathy patients compared with standard medical treatments,” we aimed to evaluate the clinical outcomes, including overall survival (OS) and sudden cardiac death (SCD), of participants with nonischemic DCM who were only treated with standard medical treatments such as angiotensin‐converting enzyme (ACE) inhibitors and beta‐blockers compared to those who underwent ICD, in addition to the above‐mentioned routine medical treatments. 2 As previously mentioned in the methodology section of our article, SCD was considered as mortality due to cardiac arrhythmias. OS was defined as mortalities due to all causes, such as cerebral emboli, severe heart failure, and pulmonary edema.…”