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Type: Journal article
Title: Primary prevention implantable cardioverter-defibrillator and opportunities for sudden cardiac death risk assessment in non-ischaemic cardiomyopathy
Author: Pathak, R.
Sanders, P.
Deo, R.
Citation: European Heart Journal, 2018; 39(31):2859-2866
Publisher: Oxford University Press
Issue Date: 2018
ISSN: 0195-668X
Statement of
Rajeev K. Pathak, Prashanthan Sanders and Rajat Deo
Abstract: Sudden cardiac death (SCD) accounts for approximately one-third of all deaths among patients with non-ischaemic cardiomyopathy (NICM). Implantable cardioverter-defibrillator (ICD) therapy has been the primary intervention for managing individuals at high risk for SCD. However, individual ICD trials in the NICM population have failed to demonstrate a mortality benefit with prophylactic ICD implantation. Current guidelines recommend ICD implantation in NICM patients with symptomatic heart failure and a left ventricular ≤35% and are based on meta-analyses of multiple trials that span three decades and include the recent Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischaemic Heart Failure on Mortality (DANISH) trial. These pooled analyses report a significant reduction in all-cause mortality with ICD implantation compared with medical therapy alone. In addition, each of these trials has demonstrated consistently a reduction in the risk of SCD compared with medical therapy alone. As a result, a refined approach of risk stratification that selects patients at the highest risk for SCD may lead to a significant improvement in ICD efficacy. In this clinical review, we first discuss the evolution of clinical trials that have evaluated ICDs in the NICM population. We then highlight some key markers of arrhythmia risk that hold promise in personalizing risk stratification for SCD.
Keywords: Humans
Death, Sudden, Cardiac
Genetic Markers
Risk Assessment
Defibrillators, Implantable
Primary Prevention
Ventricular Remodeling
Arrhythmias, Cardiac
Rights: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email:
DOI: 10.1093/eurheartj/ehy344
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