Using left ventricular ejection fraction <30%-35% as the primary indication for ICD implantation has limitations, as it lacks a direct mechanistic link to ventricular tachyarrhythmias.
Current guidelines for use of implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden death in patients with coronary disease and nonischemic dilated cardiomyopathy are based primarily on ejection fraction (EF) 35% as a group are at lower risk for sudden death, these patients are not uniform with regard to other prognostic variables. A variety of tests, including measures of reduced repolarization reserve and measures of altered sympathetic/parasympathetic balance, have identified patients with EF >35% at relatively high risk for sudden death. One explanation for this "disconnect" is that there is no evidence of any direct mechanistic link between low EF and mechanisms responsible for ventricular tachyarrhythmias.
Buxton et al. (Fri,) conducted a review in Coronary disease and nonischemic dilated cardiomyopathy. Implantable cardioverter-defibrillators (ICDs) was evaluated. Using left ventricular ejection fraction <30%-35% as the primary indication for ICD implantation has limitations, as it lacks a direct mechanistic link to ventricular tachyarrhythmias.