Assessment of ICD eligibility in non-ischaemic cardiomyopathy patients: a position statement by the Task Force of the Dutch Society of Cardiology

International guidelines recommend implantation of an implantable cardioverter-defibrillator (ICD) in non-ischaemic cardiomyopathy (NICM) patients with a left ventricular ejection fraction (LVEF) below 35% despite optimal medical therapy and a life expectancy of more than 1 year with good functional...

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Bibliographic Details
Published in:Netherlands heart journal 2024-05, Vol.32 (5), p.190-197
Main Authors: van der Lingen, Anne-Lotte C. J., Verstraelen, Tom E., van Erven, Lieselot, Meeder, Joan G., Theuns, Dominic A., Vernooy, Kevin, Wilde, Arthur A. M., Maass, Alexander H., Allaart, Cornelis P.
Format: Article
Language:English
Subjects:
Cardiac arrhythmia
Cardiology
Cardiomyopathy
Ejection fraction
Genes
Genetic testing
Heart failure
Ischemia
Medical Education
Medicine
Medicine & Public Health
Mortality
Mutation
Position Statement
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Summary:International guidelines recommend implantation of an implantable cardioverter-defibrillator (ICD) in non-ischaemic cardiomyopathy (NICM) patients with a left ventricular ejection fraction (LVEF) below 35% despite optimal medical therapy and a life expectancy of more than 1 year with good functional status. We propose refinement of these recommendations in patients with NICM, with careful consideration of additional risk parameters for both arrhythmic and non-arrhythmic death. These additional parameters include late gadolinium enhancement on cardiac magnetic resonance imaging and genetic testing for high-risk genetic variants to further assess arrhythmic risk, and age, comorbidities and sex for assessment of non-arrhythmic mortality risk. Moreover, several risk modifiers should be taken into account, such as concomitant arrhythmias that may affect LVEF (atrial fibrillation, premature ventricular beats) and resynchronisation therapy. Even though currently no valid cut-off values have been established, the proposed approach provides a more careful consideration of risks that may result in withholding ICD implantation in patients with low arrhythmic risk and substantial non-arrhythmic mortality risk.
ISSN:1568-5888
1876-6250
DOI:10.1007/s12471-024-01859-7