Should Patients with Nonischemic Heart Failure Receive an ICD?

Implantable cardioverter–defibrillator therapy significantly reduced the risk for sudden cardiac death, but not enough to yield an overall survival benefit over usual care.

U.S. and European heart failure (HF) guidelines strongly recommend considering implantable cardioverter–defibrillator (ICD) therapy for severe left-ventricular systolic dysfunction (LVSD), regardless of the cause. However, evidence for an ICD-related survival benefit is confined largely to LVSD that is related to coronary artery disease, with some data suggesting a benefit when LVSD has a nonischemic cause (N Engl J Med 2005; 352:225).

In a partly industry-funded trial, researchers randomized 1106 symptomatic patients (median age, 64; 73% men) with nonischemic HF (LV ejection fraction ≤35%) and an elevated N-terminal pro–brain natriuretic peptide level to receive an ICD or usual care. Of the ICD group, 58% received concomitant cardiac resync…

Reviewing Author

Frederick A. Masoudi, MD, MSPH, FACC, FAHA

Disclosures

Consultant/Advisory BoardBristol Myers Squibb; CPC Clinical Research

Grant/Research SupportNational Heart, Lung, and Blood Institute

Editorial BoardsUpToDate; American College of Cardiology Self-Assessment Program (SAP)

Leadership Positions in Professional SocietiesAmerican College of Cardiology (Chair, Innovations Committee)