Implantable cardioverter defibrillators in heart failure with reduced ejection fraction after myocardial infarction: the need for contemporary evidence

Sudden cardiac death is an important cause of death after myocardial infarction. Most of these episodes are considered the result of ventricular arrhythmia, with occurrence higher where myocardial infarction has been complicated by left ventricular systolic dysfunction. The landmark Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) and sudden cardiac death in heart failure (SCD-HeFT) trials, conducted around the turn of the millennium, established that treatment with implantable cardioverter defibrillators was superior to medical therapy for prevention of mortality in this context. Successive European Society of Cardiology guidelines provide a class I recommendation for the use of implantable cardioverter defibrillators for patients with persistent severe left ventricular systolic dysfunction after myocardial infarction and medicine optimization. This narrative review considers the historical randomized clinical trial evidence, the temporal trends in rate and cause of death in this patient population, as well as improvements in medical therapy, and why this necessitates a reappraisal of the benefit of implantable cardioverter defibrillators in the post-myocardial infarction population in contemporary clinical practice. Finally, details of the PROFID-EHRA trial are reported, which seeks to address this critical evidence gap.