Prevention of sudden death in heart failure with reduced ejection fraction: do we still need an implantable cardioverter-defibrillator for primary prevention?

Abdelhamid M. Rosano G. Metra M. Adamopoulos S. Böhm M. Chioncel O. Filippatos G. Jankowska E.A. Lopatin Y. Lund L. Milicic D. Moura B. Ben Gal T. Ristic A. Rakisheva A. Savarese G. Mullens W. Piepoli M. Bayes-Genis A. Thum T. Anker S.D. Seferovic P. Coats A.J.S.
September 2022 John Wiley and Sons Ltd

European Journal of Heart Failure
2022 #24 Issue 9 1460 - 1466 pp.

Sudden death is a devastating complication of heart failure (HF). Current guidelines recommend an implantable cardioverter-defibrillator (ICD) for prevention of sudden death in patients with HF and reduced ejection fraction (HFrEF) specifically those with a left ventricular ejection fraction ≤35% after at least 3 months of optimized HF treatment. The benefit of ICD in patients with symptomatic HFrEF caused by coronary artery disease has been well documented; however, the evidence for a benefit of prophylactic ICD implantation in patients with HFrEF of non-ischaemic aetiology is less strong. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers (BB), and mineralocorticoid receptor antagonists (MRA) block the deleterious actions of angiotensin II, norepinephrine, and aldosterone, respectively. Neprilysin inhibition potentiates the actions of endogenous natriuretic peptides that mitigate adverse ventricular remodelling. BB, MRA, angiotensin receptor–neprilysin inhibitor (ARNI) have a favourable effect on reduction of sudden cardiac death in HFrEF. Recent data suggest a beneficial effect of sodium–glucose cotransporter 2 inhibitors (SGLT2i) in reducing serious ventricular arrhythmias and sudden cardiac death in patients with HFrEF. So, in the current era of new drugs for HFrEF and with the optimal use of disease-modifying therapies (BB, MRA, ARNI and SGLT2i), we might need to reconsider the need and timing for use of ICD as primary prevention of sudden death, especially in HF of non-ischaemic aetiology.

Heart failure with reduced ejection fraction , Implantable cardioverter-defibrillator , Sudden death

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Faculty of Medicine, Kasr Al Ainy, Cardiology Department, Cairo University, Cairo, Egypt
St Georges Hospitals, NHS Trust, University of London, London, United Kingdom
Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
Heart Failure - Transplant - Mechanical Circulatory Support Unit, Onassis Cardiac Surgery Center, Athens, Greece
Universitatsklinikum des Saarlandes, Klinik fur Innere Medizin III, Saarland University, Kardiologie, Angiologie und Internistische Intensivmedizin, Homburg, Saar, Germany
Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’, University of Medicine Carol Davila, Bucharest, Romania
National and Kapodistrian University of Athens, School of Medicine, University Hospital Attikon, Athens, Greece
Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
Volgograd State Medical University, Regional Cardiology Centre, Volgograd, Russian Federation
Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
University of Zagreb School of Medicine, Zagreb, Croatia
Armed Forces Hospital, Porto, & Faculty of Medicine, University of Porto, Porto, Portugal
Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel, & Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Department of Cardiology, University Clinical Center of Serbia, Belgrade University School of Medicine, Belgrade, Serbia
Scientific Research Institute of Cardiology and Internal Medicine, Almaty, Kazakhstan
Cardiovascular Physiology, Hasselt University, Belgium, & Heart Failure and Cardiac Rehabilitation Specialist, Ziekenhuis Oost-Limburg, Genk, Belgium
Cardiac Unit, Guglielmo da Saliceto Hospital, University of Parma, Piacenza, Italy
Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona & CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
Institute of Molecular and Therapeutic Strategies, Hannover & Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
Department of Cardiology (CVK), and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charite Universitatsmedizin, Berlin, Germany
Department Faculty of Medicine, University of Belgrade, Belgrade & Serbian Academy of Sciences and Arts, Belgrade, Serbia
University of Warwick, Coventry, United Kingdom

Faculty of Medicine
St Georges Hospitals
Institute of Cardiology
Heart Failure - Transplant - Mechanical Circulatory Support Unit
Universitatsklinikum des Saarlandes
Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’
National and Kapodistrian University of Athens
Institute of Heart Diseases
Volgograd State Medical University
Department of Medicine
University of Zagreb School of Medicine
Armed Forces Hospital
Department of Cardiology
Department of Cardiology
Scientific Research Institute of Cardiology and Internal Medicine
Cardiovascular Physiology
Cardiac Unit
Heart Institute
Institute of Molecular and Therapeutic Strategies
Department of Cardiology (CVK)
Department Faculty of Medicine
University of Warwick

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