Incidence of Appropriate Shock in Implantable Cardioverter-Defibrillator Patients With Improved Ejection Fraction

Naksuk, Niyada; Saab, Ali; Li, Jian Ming; Florea, Viorel G.; Akkaya, Mehmet; Anand, Inder S.; Benditt, David G.; Adabag, Selçuk

doi:10.1016/j.cardfail.2013.04.007

Cited by 59 publications

(63 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a study of 187 nonischemic cardiomyopathy patients with LVEF <36% at baseline, patients with an improved LVEF (increased >5%) exhibited improved survival and a nonsignificant decrease in the risk of appropriate shocks compared to patients with stable (absolute change ≤5%) or decreased (<-5%) LVEF (8). In another study of 91 patients (99% male) with primary prevention ICDs, 27% had improved LVEF at generator replacement; however, the incidence rates of appropriate shock were similar between patients with improved LVEF and unchanged LVEF (6). Of note, among the 16 patients with improved LVEF and no ICD therapy before generator replacement, 3 (19%) had their first appropriate ICD therapy after generator replacement (6).…”

Section: Discussionmentioning

confidence: 98%

“…In another study of 91 patients (99% male) with primary prevention ICDs, 27% had improved LVEF at generator replacement; however, the incidence rates of appropriate shock were similar between patients with improved LVEF and unchanged LVEF (6). Of note, among the 16 patients with improved LVEF and no ICD therapy before generator replacement, 3 (19%) had their first appropriate ICD therapy after generator replacement (6). With a larger and more inclusive primary prevention ICD cohort (29.9% female and 39.4% blacks), we found that changes in LVEF measurements during follow-up were inversely associated with all-cause mortality and appropriate shocks and the associations were similar among ICD and CRT-D patients.…”

Section: Discussionmentioning

confidence: 98%

“…Left ventricular ejection fraction (LVEF) is a key criterion in determining eligibility for a primary prevention ICD (5). However, 25% to 40% of primary prevention ICD patients improve their LVEF to >35% after ICD implantation (6–9), calling in question whether their risk for SCD warrants ICD generator replacement especially in patients who have not experienced any appropriate ICD therapy. Additionally, it is largely unknown if improvement in LVEF affects the subsequent risk for mortality and SCD since prior studies were limited by small sample size and lack of repeated LVEF assessments during follow-up (6–9).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Changes in Follow-Up Left Ventricular Ejection Fraction Associated With Outcomes in Primary Prevention Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy Device Recipients

Zhang

Güallar

Blasco-Colmenares

et al. 2015

Journal of the American College of Cardiology

View full text Add to dashboard Cite

BACKGROUND Heart failure patients with primary prevention implantable cardioverter-defibrillators (ICD) may experience an improvement in left ventricular ejection fraction (LVEF) over time. However, it is unclear how LVEF improvement affects subsequent risk for mortality and sudden cardiac death (SCD). OBJECTIVES We sought to assess changes in LVEF after ICD implantation and the implication of these changes on subsequent mortality and ICD shocks. METHODS We conducted a prospective cohort study of 538 patients with repeated LVEF assessments after ICD implantation for primary prevention of SCD. The primary endpoint was appropriate ICD shock, defined as a shock for ventricular tachyarrhythmias. The secondary endpoint was all-cause mortality. RESULTS Over a mean follow-up of 4.9 years, LVEF decreased in 13.0%, improved in 40.0%, and was unchanged in 47.0% of the patients. In the multivariate Cox models comparing patients with an improved LVEF to those with an unchanged LVEF, the hazard ratios were 0.33 (95% confidence interval [CI]: 0.18 to 0.59) for mortality and 0.29 (95% CI: 0.11 to 0.78) for appropriate shock, respectively. During follow-up, 25% of patients showed an improvement in LVEF to >35% and their risk of appropriate shock decreased but was not eliminated. CONCLUSION Among primary prevention ICD patients, 40.0% had an improved LVEF during follow-up and 25% had LVEF improved to >35%. Changes in LVEF were inversely associated with all-cause mortality and appropriate shock for ventricular tachyarrhythmia. In patients whose follow-up LVEF improved to >35%, the risk of an appropriate shock remained but was markedly decreased.

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Changes in Follow-Up Left Ventricular Ejection Fraction Associated With Outcomes in Primary Prevention Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy Device Recipients

Zhang

Güallar

Blasco-Colmenares

et al. 2015

Journal of the American College of Cardiology

View full text Add to dashboard Cite

show abstract

“…Recent evidence suggests that improved LVEF is associated with a decrease in all-cause mortality and appropriate ICD shock for ventricular tachyarrhythmia,. 2–6 …”

Section: Introductionmentioning

confidence: 99%

Associations between scar characteristics by cardiac magnetic resonance and changes in left ventricular ejection fraction in primary prevention defibrillator recipients

et al. 2016

View full text Add to dashboard Cite

BACKGROUND Left ventricular ejection fraction (LVEF) improves over time in 25%–40% of cardiomyopathy patients with primary prevention implantable cardioverter-defibrillators (ICD). The determinants of LVEF improvement, however, are not well characterized. OBJECTIVES We sought to examine the associations of clinical risk factors and cardiac imaging markers with changes in LVEF following ICD implantation. METHODS We conducted a retrospective analysis of cardiac magnetic resonance (CMR) images in 202 patients who underwent primary prevention ICD implantation to quantify the amount of heterogeneous myocardial tissue (gray zone [GZ]), dense core and total scar. LVEF was reassessed at least once after ICD implantation. RESULTS Over a mean follow-up of 3 years, LVEF decreased in 21.3%, improved in 43.6%, and was unchanged in 35.1% of the patients. Baseline LVEF and myocardial scar characteristics were the strongest determinants of LVEF trajectory with high scar burden and increasing lack of myocardial viability associated with a greater decline in LVEF. There was a trend toward an association between both changes in LVEF and scar extent with subsequent appropriate ICD shock. Changes in LVEF were also strongly associated with heart failure (HF) hospitalizations. CONCLUSIONS Scar burden and characteristics were strong determinants, independent of baseline LVEF and other traditional cardiovascular risk factors, of changes in LVEF. Both worsened LVEF and high scar extent were associated with a trend toward increased risk of appropriate shock. These findings suggest that baseline CMR imaging of the myocardial substrate may provide important prognostic information regarding subsequent LV remodeling and adverse events.

show abstract

“…One study examined the incidence of appropriate ICD shocks among 91 patients with ICDs for the primary prevention of sudden death, and 27% of them had an improved EF (>10% absolute increase since original implantation and EF >35%) when they presented for elective replacement of their device [13]. During a 6-year follow-up since the first ICD implant, patients with and those without an improved EF had a similar incidence of appropriate ICD shocks and/or antitachycardia pacing.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Mechanical Reverse Remodelling Not Followed by Electrical Reverse Remodelling: A Case Report

Amorim¹,

García²,

Pinho³

et al. 2017

Cardiology

View full text Add to dashboard Cite

Patients with severely depressed left ventricular ejection fractions (LVEFs) receive implantable cardioverter-defibrillators (ICDs) for the primary prevention of sudden death. However, in some patients, LVEFs may improve or even normalize over time, and these patients would no longer be qualified for ICD implantation based on the original criteria for which they have initially received an ICD. We report a patient with idiopathic dilated cardiomyopathy whose LVEF recovered to normal values after pharmacological therapy. Meanwhile, the patient had life-threatening ventricular fibrillation, aborted by the ICD. We reflect on the pathological features of left ventricular reverse remodelling and ventricular arrhythmogenesis, where the myocardial substrate appears to play an important role. Also, after LVEF improvement in a patient with a cardiac device, there is still a debate on whether we should perform a battery replacement.

show abstract

Incidence of Appropriate Shock in Implantable Cardioverter-Defibrillator Patients With Improved Ejection Fraction

Cited by 59 publications

References 22 publications

Changes in Follow-Up Left Ventricular Ejection Fraction Associated With Outcomes in Primary Prevention Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy Device Recipients

Changes in Follow-Up Left Ventricular Ejection Fraction Associated With Outcomes in Primary Prevention Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy Device Recipients

Associations between scar characteristics by cardiac magnetic resonance and changes in left ventricular ejection fraction in primary prevention defibrillator recipients

Left Ventricular Mechanical Reverse Remodelling Not Followed by Electrical Reverse Remodelling: A Case Report

Contact Info

Product

Resources

About