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

• 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
• ISSN: 1388-9842; 1879-0844; 1879-0844
• DOI: 10.1002/ejhf.2594

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.