Arrhythmic risk following recovery of left ventricular ejection fraction in patients with primary prevention ICD

Auteur(s): Berthelot Richer, Maxime; Bonenfant, Francis; Clavel, Marie-Annick; Farand, Paul; Philippon, François; Ayala-Parades, Félix; Essadiqi, Btissama; Badra-Verdu, Mariano Gonzalo; Roux, Jean-François
Résumé: 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.
Type de document: Article de recherche
Date de publication: 5 mai 2016
Date de la mise en libre accès: Accès restreint
Version du document: VoR
Lien permanent: http://hdl.handle.net/20.500.11794/5688
Ce document a été publié dans: Pacing and clinical electrophysiology (2016)
https://doi.org/10.1111/pace.12868
North American Society of Pacing & Electrophysiology
Autre version disponible: 10.1111/pace.12868
27062583
Collection :Articles publiés dans des revues avec comité de lecture

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