Key result
Early rhythm control with WCD linked to LVEF recovery and ~3% ICD need in arrhythmia-induced cardiomyopathy.
Why the study?
Arrhythmia-induced cardiomyopathy is a potentially reversible cause of heart failure, but data on its real-world prevalence, recognition, and outcomes are limited.
Does early rhythm control under wearable cardioverter-defibrillator protection improve LVEF and reduce ICD indications in patients with newly diagnosed idiopathic LVSD and concurrent arrhythmia?
Does early rhythm control under wearable cardioverter-defibrillator protection improve LVEF and reduce ICD indications in patients with newly diagnosed idiopathic LVSD and concurrent arrhythmia?
Early rhythm control in patients with newly diagnosed LVSD and concurrent arrhythmia frequently leads to significant LVEF recovery, reducing the need for permanent ICD implantation.
May support early rhythm control in suspected AIC; leaves open reliable predictors of LVEF recovery.
Background Arrhythmia‐induced cardiomyopathy (AIC) is a potentially reversible cause of heart failure triggered by different sustained arrhythmias, but data on its real‐world prevalence, recognition, and outcomes are limited. Objective To assess frequency, predictors, and outcomes of AIC in patients with newly diagnosed left ventricular systolic dysfunction (LVSD) and concurrent arrhythmia undergoing early rhythm control with a wearable cardioverter‐defibrillator (WCD). Methods Among 780 WCD‐treated patients (2017–2023), those with newly diagnosed idiopathic LVSD (LVEF < 35%) and persistent arrhythmia (atrial fibrillation/flutter or > 20% ventricular ectopy) were included. Diagnostic workup comprised echocardiography, coronary angiography, and cardiac MRI. Effective rhythm control was achieved via cardioversion, antiarrhythmic drugs, and/or ablation. Follow‐up was up to 6 months. AIC was defined as LVEF improvement > 15% with restored sinus rhythm or suppressed ventricular ectopy. Results Of 780 WCD patients, 142 (18.2%) had LVSD with arrhythmia; 74 idiopathic cases were analyzed. At a mean follow‐up of 138 days (4.5 months), 54 patients (73%) maintained sinus rhythm or suppressed ventricular ectopy after rhythm control, of whom 32 (59.3%) fulfilled AIC criteria. LVEF improved from 28% to 43% in AIC; 56.3% of AIC patients fully recovered (> 50%). Non‐AIC patients had larger LV dimensions, lower heart rates, more mitral regurgitation, and a non‐significant trend toward more frequent late gadolinium enhancement ( p = 0.073). No parameter reliably predicted AIC; LVEF < 25% predicted lack of full recovery ( p = 0.040). No appropriate WCD shocks occurred. ICD indication decreased from 100% to 17% post‐therapy in AIC and Non‐AIC patients (3.1% vs . 36.4%, p = 0.001). Conclusions AIC related to atrial fibrillation, flutter, or frequent ventricular ectopy is more prevalent and reversible than often recognized. Early rhythm control under WCD protection, supported by comprehensive diagnostics, allows identification of reversible LVSD and may help prevent unnecessary ICD implantation.
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Yogarajah et al. (2026) studied this question. Early rhythm control under wearable defibrillator protection in LVSD patients improved LVEF from 28% to 43% in those with arrhythmia-induced cardiomyopathy, reducing ICD need to 3.1%.
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