Key result
Stratification by the 2023 Dutch guideline showed no significant difference in appropriate ICD therapy between patients with and without an ICD indication (16% vs 12%, p=0.623).
Why the study?
Evidence for a survival benefit from primary prevention ICDs in NICMP is not robust, prompting a 2023 Dutch guideline update to refine patient selection.
Does the 2023 Dutch guideline accurately identify patients with non-ischaemic cardiomyopathy who will benefit from primary prevention ICD therapy?
Observational (n=99)
No
Does the 2023 Dutch guideline accurately identify patients with non-ischaemic cardiomyopathy who will benefit from primary prevention ICD therapy?
Answers are grounded in this paper and cite their sources.
Similar appropriate ICD therapy rates regardless of indication; leaves open the 2023 Dutch guideline's accuracy for primary prevention ICD selection in non-ischaemic cardiomyopathy.
INTRODUCTION: Patients with non-ischaemic cardiomyopathy (NICMP) have a class IIa primary prevention indication for an implantable cardioverter-defibrillator (ICD). Recent studies have shown that the evidence for a survival benefit following ICD implantation in this patient group is not particularly robust. In 2023, the Dutch Society of Cardiology published an update of the ESC guideline to better select patients with NICMP for ICD implantation. The objective of this study was to analyse the impact of this guideline on the number of indications in a retrospective cohort of patients who had received an ICD and whether the patients without an indication were also without appropriate ICD therapy. METHODS: A single-centre, retrospective observational study was performed in 134 patients with NICMP who underwent ICD implantation for primary prevention between 2015 and 2020. RESULTS: After applying the new Dutch guideline, 74 out of 134 patients with NICMP without a high-risk phenotype (35 patients) had no ICD indication (group 2). The remaining 25 patients were considered to have an ICD indication (group 1). During a median follow-up of 66 months (interquartile range 52-81) the incidence of appropriate ICD therapy (antitachycardia pacing and shock) was comparable in both groups: 4 patients in group 1 (16%) and 9 in group 2 (12%), p = 0.623. CONCLUSION: The new 2023 guideline for ICD implantation in NICMP patients does indeed rule out a significant group of patients from ICD implantation. Nevertheless, our data show that patients without an indication still had comparable rates of appropriate ICD therapy.
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Evertz et al. (2025) conducted an observational in Non-ischaemic cardiomyopathy (NICMP) (n=99). ICD indication according to 2023 Dutch guideline vs. No ICD indication according to 2023 Dutch guideline was evaluated on Incidence of appropriate ICD therapy (antitachycardia pacing and shock) (p=0.623). Stratification by the 2023 Dutch guideline showed no significant difference in appropriate ICD therapy between patients with and without an ICD indication (16% vs 12%, p=0.623).
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