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

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% af...

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Published in:European journal of heart failure 2022-09, Vol.24 (9), p.1460-1466
Main Authors: Abdelhamid, Magdy, Rosano, Giuseppe, Metra, Marco, Adamopoulos, Stamatis, Böhm, Michael, Chioncel, Ovidiu, Filippatos, Gerasimos, Jankowska, Ewa A., Lopatin, Yury, Lund, Lars, Milicic, Davor, Moura, Brenda, Ben Gal, Tuvia, Ristic, Arsen, Rakisheva, Amina, Savarese, Gianluigi, Mullens, Wilfried, Piepoli, Massimo, Bayes‐Genis, Antoni, Thum, Thomas, Anker, Stefan D., Seferovic, Petar, Coats, Andrew J.S.
Format: Article
Language:English
Subjects:
Adrenergic beta-Antagonists - therapeutic use
Aldosterone
Angiotensin II - pharmacology
Angiotensin II - therapeutic use
Angiotensin Receptor Antagonists - pharmacology
Angiotensin Receptor Antagonists - therapeutic use
Angiotensin-Converting Enzyme Inhibitors - pharmacology
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Death, Sudden, Cardiac - etiology
Death, Sudden, Cardiac - prevention & control
Defibrillators, Implantable
Heart Failure - drug therapy
Heart Failure - therapy
Heart failure with reduced ejection fraction
Humans
Implantable cardioverter‐defibrillator
Medicin och hälsovetenskap
Mineralocorticoid Receptor Antagonists - pharmacology
Mineralocorticoid Receptor Antagonists - therapeutic use
Neprilysin
Norepinephrine - pharmacology
Norepinephrine - therapeutic use
Primary Prevention
Receptors, Angiotensin - therapeutic use
Sodium-Glucose Transporter 2 Inhibitors - pharmacology
Sodium-Glucose Transporter 2 Inhibitors - therapeutic use
Stroke Volume - physiology
Sudden death
Ventricular Function, Left
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Summary: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.
ISSN:1388-9842
1879-0844
1879-0844
DOI:10.1002/ejhf.2594