@article{3158464,
    title = "Implantable cardioverter defibrillator therapy activation for high risk
patients with relatively well preserved left ventricular ejection
fraction. Does it really work?",
    author = "Gatzoulis, Konstantinos A. and Tsiachris, Dimitris and Dilaveris, and Polichronis and Archontakis, Stefanos and Arsenos, Petros and Vouliotis, and Apostolis and Sideris, Skevos and Trantalis, George and Kartsagoulis, and Efstathios and Kallikazaros, Ioannis and Stefanadis, Christodoulos",
    journal = "International Journal of Cardiology",
    year = "2013",
    volume = "167",
    number = "4",
    pages = "1360-1365",
    publisher = "Elsevier Ireland Ltd",
    issn = "0167-5273",
    doi = "10.1016/j.ijcard.2012.04.005",
    keywords = "Implantable cardioverter defibrillator; Left ventricular ejection
fraction; Programmed ventricular stimulation",
    abstract = "Background: Current guidelines for the primary prevention of sudden
cardiac death have used a left ventricular ejection fraction (LVEF) <=
35% as a critical point to justify implantable cardioverter
defibrillator (ICD) implantation in post myocardial infarction patients
and in those with nonischemic dilated cardiomyopathy. We compared
mortality and ICD activation rates among different ICD group recipients
using a cut-off value for LVEF <= 35%.
Methods: We followed up for a mean period of 41.1 months 495 ICD
recipients (442 males, 65.6 years old, 68.9% post myocardial infarction
patients, 422 with LVEF <= 35%). Prevention was considered primary in
patients who fulfilled guidelines criteria or had inducible ventricular
arrhythmia during programmed ventricular stimulation for patients with
LVEF >35%.
Results: Over the course of the trial, 84 of 495 patients died; 69
experienced cardiac death (6 sudden) and 15 non cardiac death. ICD
recipients with LVEF <= 35% compared to those with preserved LVEF (mean
LVEF=43%) had a greater incidence of totalmortality (18% vs. 11%, log
rank p=0.028) and cardiac death (15.4% vs. 5.5%, log rank p=0.005).
There was no difference in the incidence for appropriate device therapy
between patients with LVEF <= 35% and those with LVEF>35% (56.9% vs.
65.8%, log rank p=0.93). In the multivariate analysis the presence of
advanced New York Heart Association stage predicted both total mortality
(HR=2.69, 95% CI 1.771-4.086) and cardiac death (HR=3.437, 95% CI
2.163-5.463).
Conclusions: ICD therapy may protect heart failure patients at early
stages from arrhythmic morbidity and mortality, based on an
electrophysiology-guided risk stratification approach. (C) 2012 Elsevier
Ireland Ltd. All rights reserved."
}