Withholding ICDs after EF improves to > 35% can not be justified in all patients with CAD and left ventricular systolic dysfunction (LVSD)

Authors

Indrajit Choudhuri, Advocate Aurora HealthFollow
Kanwar Yugraj Singh
Firas Zahwe, Advocate Aurora HealthFollow
Tadele Mangesha, Advocate Aurora HealthFollow
Robyn Shearer, Advocate Aurora HealthFollow
Crystal Platz, Advocate Aurora HealthFollow
Bilal Omery, Advocate Aurora HealthFollow
Arshad Jahangir, Advocate Aurora HealthFollow
M. Eyman Mortada, Advocate Aurora HealthFollow
Jasbir Sra, Advocate Aurora HealthFollow
Masood Akhtar, Advocate Aurora HealthFollow

Recommended Citation

Choudhuri I, Singh KY, Zahwe F, et al. Withholding ICDs after EF improves to > 35% can not be justified in all patients with CAD and left ventricular systolic dysfunction (LVSD). Heart Rhythm. 2017;14(5):S566-S566. doi:10.1016/j.hrthm.2017.04.011.

Affiliations

Aurora Cardiovascular Services

Aurora Sinai/Aurora St. Luke’s Medical Centers

Aurora Research Institute

Center for Integrative Research on CV Aging - Aurora Health Care

Presentation Notes

Poster presented at: Heart Rhythm Scientific Sessions; May 11, 2017; Chicago, IL.

Abstract

BACKGROUND: When EF≤35% is identified, ICDs are considered for SCD protection, but are withheld if EF improves to >35% within 90 days. This practice is not supported by direct evidence and may leave a significant segment of the population exposed to SCD risk.

OBJECTIVE: Evaluate relationship of EF to timing of appropriate ICD therapy, as well as impact of withholding ICD after EF improves to >35%, in CAD patients with at least moderate LVSD.

METHODS: Aurora Healthcare patients with EF≤35% and subsequent improvement at any time to EF>35% were included; excluding patients with: EF recovery in ≤7 days, CRT, LVAD, transplant, and inherited sudden death syndromes. After propensity matching, the study cohort (n=798) was segregated by presence/absence of ICD. SCD events and appropriate ICD therapies (ApprRx) were tabulated in ICD patients, as well as EF at the time of the event.

RESULTS: Of 133 ICD recipients (48.1%>65 years, 31.6% female) 6% suffered ApprRx over 23±13 months. In 62.5% of patients with ApprRx the EF was confirmed >35%, including in 75% of primary prevention patients with AppRx. In secondary prevention (2°) patients, a greater percentage (25%) of patients with EF>35% received ApprRx, compared to those with EF≤35% (7.1%). Alarmingly, 22.2% of 2° patients did not have an ICD at the time of their initial SCD event because they were disqualified due to EF recovery.

CONCLUSION: In patients with CAD, the ICD provides sudden death protection even after EF improves to >35%. The practice of withholding ICD therapy for EF recovery to >35% was associated with sudden death events in this analysis, and requires reexamination.

Document Type

Abstract