Affiliation:
1. Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
Abstract
Background
Optimal timing of implantation of an implantable cardioverter/defibrillator (
ICD
) after newly diagnosed heart failure is unclear given that late reverse remodelling may occur. We aimed to analyze left ventricular ejection fraction (
LVEF
) after diagnosis of an
LVEF
≤35% during optimization of heart failure drug therapy.
Methods and Results
One hundred fifty‐six patients with newly diagnosed
LVEF
≤35% receiving a wearable cardioverter/defibrillator (
WCD
) were analyzed.
WCD
was prescribed for 3 months until first re‐evaluation. Indications for prolongation of
WCD
wearing period instead of
ICD
implantation were: (1)
LVEF
at 3‐month visit 30% to 35%; (2) increase in
LVEF
of ≥5% compared to the last visit; and (3) nonoptimized heart failure medication. Mean
LVEF
was 24±7% at diagnosis and 39±11% at last follow‐up (mean, 12±10 months). Whereas 88 patients presented a primary preventive
ICD
indication (
LVEF
≤35%) at 3‐month follow‐up, only 58 showed a persistent primary preventive
ICD
indication at last follow‐up. This delayed improvement in
LVEF
was related to nonischemic origin of cardiomyopathy, New York Heart Association functional class at baseline, heart rate, better
LVEF
after 3 months, and higher dosages of mineralocorticoid receptor antagonist. Twelve appropriate
WCD
shocks for ventricular tachycardia/ventricular fibrillation occurred in 11 patients. Two patients suffered from ventricular tachycardia/ventricular fibrillation beyond 3 months after diagnosis.
Conclusions
A relevant proportion of patients with newly diagnosed heart failure shows recovery of
LVEF
>35% beyond 3 months after initiation of heart failure therapy. To avoid untimely
ICD
implantation, prolongation of
WCD
period should be considered in these patients to prevent sudden cardiac death while allowing left ventricular reverse remodeling during intensified drug therapy.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
69 articles.
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