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Timing of Prophylactic Implantable Cardioverter-Defibrillator Implantation in Patients With Cardiomyopathy

      The recent study by Zecchin et al
      • Zecchin M.
      • Merlo M.
      • Pivetta A.
      • Barbati G.
      • Lutman C.
      • Gregori D.
      • Serdoz L.V.
      • Bardari S.
      • Magnani S.
      • Di Lenarda A.
      • Proclemer A.
      • Sinagra G.
      How can optimization of medical treatment avoid unnecessary implantable cardioverter-defibrillator implantations in patients with idiopathic dilated cardiomyopathy presenting with “SCD-HeFT criteria?”.
      is an important contribution to the debate regarding the appropriate timing of prophylactic implantable cardioverter-defibrillator (ICD) implantation for patients with idiopathic dilated cardiomyopathy (DC). They have shown that with optimal medical therapy, 2/3 of patients with DC and “SCD-HeFT [Sudden Cardiac Death in Heart Failure] criteria” at presentation
      • Bardy G.H.
      • Lee K.L.
      • Mark D.B.
      • Poole J.E.
      • Packer D.L.
      • Boineau R.
      • Domanski M.
      • Troutman C.
      • Anderson J.
      • Johnson G.
      • McNulty S.E.
      • Clapp-Channing N.
      • Davidson-Ray L.D.
      • Fraulo E.S.
      • Fishbein D.P.
      • Luceri R.M.
      • Ip J.H.
      Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators
      Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure.
      did not maintain ICD indications 3 to 9 months later. We wish to extend these observations by showing that even in patients with advanced heart failure and very low left ventricular ejection fractions (LVEFs), intensive medical management without ICD implantation can be associated with an exceptionally low 1-year mortality and, in many cases, with an improvement of the LVEF to >35%.
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