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Risk of Appropriate Implantable Cardioverter-Defibrillator Therapies and Sudden Cardiac Death in Patients With Heart Failure With Improved Left Ventricular Ejection Fraction
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  • Mohammed Al-sadawi,
  • Chad Gier,
  • Michael Tao,
  • Matthew Henriques,
  • Paul Kim,
  • Faisal Aslam,
  • Ibrahim Almasry,
  • Abhijeet Singh,
  • Roger Fan,
  • Eric Rashba
Mohammed Al-sadawi
Stony Brook University Hospital
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Chad Gier
Stony Brook University Hospital
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Michael Tao
Stony Brook University Hospital
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Matthew Henriques
Stony Brook University Hospital
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Paul Kim
Stony Brook University Hospital
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Faisal Aslam
Stony Brook University Hospital
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Ibrahim Almasry
Stony Brook University Hospital
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Abhijeet Singh
Stony Brook University Hospital
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Roger Fan
Stony Brook University Hospital
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Eric Rashba
Stony Brook University Hospital

Corresponding Author:[email protected]

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Abstract

Background The benefit of implantable cardioverter defibrillator (ICD) therapy in patients who have heart failure with improved left ventricular ejection fraction (LVEF) to >35% after implantation (HFimpEF) is controversial. Methods Databases (Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar) were queried for studies of ICD patients that reported the association between HFimpEF and arrhythmic events (AEs), defined as the combined incidence of ventricular arrhythmias, appropriate ICD intervention and sudden cardiac death (primary composite endpoint). Results A total of 41 studies and 38,572 patients (11,135 with HFimpEF, 27,437 with persistent EF <35%) were included; mean follow up was 43 months. HFimpEF was associated with decreased AEs (OR 0.39, 95% CI 0.32-0.47; annual rate (AR) 4.1% vs. 8%; P<0.01). Super-responders (EF >50%) had a lower risk of AEs than patients with more modest reverse remodeling (EF>35% and <50%, OR 0.25, 95% CI 0.14-0.46; AR 2.7% vs. 6.2%; P<0.01). HFimpEF patients who had an initial primary prevention indication had a lower risk of AEs (OR 0.43, 95% CI 0.3-0.61; AR 5.1% vs. 10.3%; P<0.01). Among primary prevention patients who had never received appropriate ICD therapy at the time of generator change, HFimpEF was associated with decreased subsequent AEs (OR 0.26, 95% CI 0.12-0.59; AR 1.6% vs. 4.8%; P<0.01). Conclusion HFimpEF is associated with reduced, but not eliminated, risk for AEs in patients with ICDs. The decision for replacing an ICD in lower risk subgroups should incorporate shared decision making based on risks for subsequent AEs and procedural complications.