Why the study?
Patients with heart failure and reduced LVEF face competing risks of VT/VF, pump failure, and noncardiac death, prompting evaluation of the LVEF-VT/VF relationship accounting for nonarrhythmic mortality.
Does very low LVEF (≤20%) increase the risk of sustained VT/VF and ICD shocks compared to higher LVEF (>20%) in primary prevention ICD recipients with heart failure?
Population
5,168 primary prevention ICD recipients from 5 major trials
Comparison
LVEF tertiles (≤20% vs 21%-29% vs 30%-35%)
Design
Pooled cohort analysis of 5 trials
Follow-up
3 years
Key result
Primary prevention ICD recipients with LVEF ≤20% had a 23% higher cumulative incidence of sustained VT/VF compared with those with LVEF >20% (P=0.004).
Authors
Loading...
LVEF ≤20% identifies higher arrhythmic risk in primary prevention ICD recipients; leaves open whether thresholds should refine selection or programming.
Cohort (n=5,168)
Yes
Does very low LVEF (≤20%) increase the risk of sustained VT/VF and ICD shocks compared to higher LVEF (>20%) in primary prevention ICD recipients with heart failure?
Effect estimate: 23% higher cumulative incidence
p-value: p=0.004
In patients with advanced heart failure, very low LVEF (≤20%) is associated with a significantly higher incidence of sustained VT/VF and appropriate ICD shocks, despite a higher competing risk of nonarrhythmic mortality.
Barsheshet et al. (2026) conducted a cohort in Heart failure with reduced left ventricular ejection fraction (n=5,168). LVEF ≤20% vs. LVEF >20% was evaluated on Sustained VT/VF (23% higher cumulative incidence, p=0.004). Primary prevention ICD recipients with LVEF ≤20% had a 23% higher cumulative incidence of sustained VT/VF compared with those with LVEF >20% (P=0.004).