Key result
Improved LVEF >35% is linked to less ICD therapy despite residual arrhythmia risk.
Why the study?
ICDs prevent sudden cardiac death in heart failure, but the value of ICD therapy after LVEF recovery remains uncertain.
Does LVEF improvement to >35% reduce the risk of appropriate ICD therapy in heart failure patients with primary prevention ICDs?
Does LVEF improvement to >35% reduce the risk of appropriate ICD therapy in heart failure patients with primary prevention ICDs?
LVEF recovery to >35% significantly reduces but does not completely eliminate the risk of ventricular arrhythmias requiring ICD therapy, highlighting the need for individualized ICD management.
Residual arrhythmia risk persists after LVEF recovery; supports individualized ICD decisions but leaves open prospective validation.
Background: Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death in patients with heart failure, but the value of ICD therapy after left ventricular ejection fraction (LVEF) recovery is uncertain. Methods and Results: We retrospectively studied 118 patients undergoing primary prevention ICD therapy (2013–2022). Of them, 40 (34%) improved to LVEF >35% (impEF). Over 4.4 years, appropriate ICD therapy occurred significantly less in the impEF group vs. the persistently low LVEF group (P=0.008), but 4 impEF patients still required antitachycardia pacing therapy. No patient with LVEF ≥40% received such therapy. Conclusions: LVEF recovery reduces but does not eliminate ventricular arrhythmia risk, supporting individualized ICD management.
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Nakamura et al. (2025) studied this question. Patients with improved LVEF (>35%) had significantly less ICD therapy (P=0.008), but 4 still required pacing, indicating residual arrhythmia risk.
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