Key result
ICD-treated ventricular arrhythmia is linked to ~3.5-fold higher risk of subsequent heart failure events.
Why the study?
Ventricular arrhythmia and heart failure frequently coexist in patients with ischaemic LV dysfunction, but whether these events are bidirectionally associated and how they relate to mortality was unclear.
Are ICD-treated ventricular arrhythmias and heart failure events bidirectionally associated and independently linked to all-cause mortality in post-MI patients with persistent LVEF ≤35%?
Cohort (n=1,014)
Yes
Are ICD-treated ventricular arrhythmias and heart failure events bidirectionally associated and independently linked to all-cause mortality in post-MI patients with persistent LVEF ≤35%?
Answers are grounded in this paper and cite their sources.
In post-MI ICD recipients with persistent LV dysfunction, ventricular arrhythmias and heart failure events have a strong bidirectional relationship and both independently increase mortality risk, underscoring the need for integrated arrhythmia and heart failure management.
AIMS: Ventricular arrhythmia (VA) and heart failure (HF) frequently coexist in patients with ischaemic left ventricular (LV) dysfunction. Whether VA and HF events are bidirectionally associated remains unclear. We investigated their bidirectional relationship and associations with mortality. METHODS: We analysed 1014 patients from the multicentre WICD-MI study. All received a wearable cardioverter-defibrillator after acute myocardial infarction (MI) and subsequently underwent implantable cardioverter-defibrillator (ICD) implantation, with persistent LV ejection fraction ≤35%. Associations between ICD-treated VA, HF-events (HF hospitalization, heart transplantation, or LV assist device implantation), and all-cause mortality were assessed using time-dependent Cox models. RESULTS: Over a median follow-up of 2.6 years post-ICD implantation, VA was independently associated with an increased risk of HF events [aHR = 3.50 (1.66-7.38), P = .001], while HF events similarly preceded subsequent VA [aHR = 2.96 (1.59-5.50), P = .0008]. Both were independently associated with all-cause mortality, with a numerically higher aHR for HF events [aHR = 7.96 (4.71-13.47), P < .0001] than for VA [aHR = 4.43 (2.35-8.36), P < .0001]. Sensitivity analyses suggested that the VA-HF association was strongest for shock-treated arrhythmias. In exploratory analyses, VA was strongly associated with subsequent HF events in subcutaneous ICD recipients [aHR = 15.08 (4.62-49.22), P < .0001] but not in transvenous ICD recipients (P for interaction = .0002). CONCLUSION: In ICD recipients with persistent LV dysfunction following MI, VA and HF events are bidirectionally associated and independently associated with mortality. The VA-HF association was strongest for shock-treated arrhythmias. These findings highlight the potential value of integrated HF and VA management.
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Echivard et al. (2026) conducted a cohort in Ischaemic left ventricular dysfunction post-myocardial infarction in ICD recipients (n=1,014). ICD-treated ventricular arrhythmia (VA) and heart failure (HF) events vs. Patients without VA or HF events (time-dependent Cox models) was evaluated on Heart failure events (HF hospitalization, heart transplantation, or LV assist device implantation), subsequent VA, and all-cause mortality (aHR 3.50, 95% CI 1.66-7.38, p=.001). ICD-treated ventricular arrhythmia increased HF event risk (aHR 3.50, 95% CI 1.66-7.38; P=.001), while HF events increased subsequent VA (aHR 2.96; P=.0008) and mortality.
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