Key result
LVEF recovery to >35% was associated with a lower risk of ventricular arrhythmias requiring ICD therapy (HR 0.38; 95% CI 0.13-0.85; P=0.02), particularly in nonischemic cardiomyopathy.
Why the study?
Does LVEF recovery to >35% reduce the risk of ventricular arrhythmias requiring ICD therapy in patients with primary prevention ICDs?
Cohort (n=286)
Does LVEF recovery to >35% reduce the risk of ventricular arrhythmias requiring ICD therapy in patients with primary prevention ICDs?
Hazard Ratio: 0.38 (95% CI 0.13–0.85)
p-value: p=0.02
LVEF recovery to >35% is associated with a significantly lower risk of ventricular arrhythmias in patients with nonischemic cardiomyopathy, but not in those with ischemic cardiomyopathy, suggesting different thresholds may be needed for withholding ICD replacement.
LVEF recovery may identify lower-risk ICD patients; hypothesis-generating and should not change practice without prospective validation.
BACKGROUND: Left ventricular ejection fraction (LVEF) recovers during follow-up in a significant proportion of patients implanted with a cardioverter defibrillator (ICD) for primary prevention. Little is known about the midterm arrhythmic risk in this population, particularly in relation to the presence or absence of ischemic cardiomyopathy. METHODS AND RESULTS: We retrospectively analyzed 286 patients with an ICD implanted for primary prevention between 2002 and 2010. Patients were divided into two groups based on their last LVEF assessment: (1) Recovery, defined as an LVEF > 35%; and (2) No-Recovery, defined as an LVEF ≤ 35%. Kaplan-Meir curves and multivariate Cox regression analysis were performed separately for patients with ischemic (211 patients) and nonischemic (75 patients) cardiomyopathy. Forty-nine patients (17.1%) had LVEF recovery to >35% at last follow-up. Overall, 72 patients (25.2%) experienced ventricular arrhythmias requiring ICD therapy during a median follow-up of 4.4 years. With multivariate Cox regression, LVEF recovery was associated with a lower arrhythmic risk in the whole cohort (hazard ratio [HR]: 0.38 [0.13-0.85]; P = 0.02) and in the nonischemic cardiomyopathy cohort (HR: 0.10 [0.005-0.55]; P = 0.005), but not in the ischemic cardiomyopathy cohort (HR: 0.84 [0.25-2.10]; P = 0.74). CONCLUSION: In conclusion, patients with nonischemic cardiomyopathy who improved their LVEF to >35% after primary prevention ICD implantation were at very low absolute arrhythmic risk. Our study raises the possibility that the LVEF cutoff to safely withhold ICD replacement might be higher in patients with ischemic compared to nonischemic cardiomyopathy. This will need to be confirmed in prospective studies.
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Berthelot‐Richer et al. (2016) conducted a cohort in Primary prevention ICD (n=286). LVEF recovery (>35%) vs. No LVEF recovery (LVEF ≤ 35%) was evaluated on ventricular arrhythmias requiring ICD therapy (HR 0.38, 95% CI 0.13-0.85, p=0.02). LVEF recovery to >35% was associated with a lower risk of ventricular arrhythmias requiring ICD therapy (HR 0.38; 95% CI 0.13-0.85; P=0.02), particularly in nonischemic cardiomyopathy.
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