Revascularization and Left Ventricular Dysfunction for ICD Eligibility
Common triggers for sudden cardiac death (SCD) are transient ischemia, hemodynamic fluctuations, neurocardiovascular influences, and environmental factors. SCD occurs rapidly when sinus rhythm degenerates into ventricular tachycardia (VT) and/or ventricular fibrillation (VF), followed by asystole. S...
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MDPI AG
2023-09-01
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| Series: | Life |
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| Online Access: | https://www.mdpi.com/2075-1729/13/9/1940 |
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| author | Letizia Rosa Romano Carmen Anna Maria Spaccarotella Ciro Indolfi Antonio Curcio |
| author_facet | Letizia Rosa Romano Carmen Anna Maria Spaccarotella Ciro Indolfi Antonio Curcio |
| author_sort | Letizia Rosa Romano |
| collection | DOAJ |
| description | Common triggers for sudden cardiac death (SCD) are transient ischemia, hemodynamic fluctuations, neurocardiovascular influences, and environmental factors. SCD occurs rapidly when sinus rhythm degenerates into ventricular tachycardia (VT) and/or ventricular fibrillation (VF), followed by asystole. Such progressive worsening of the cardiac rhythm is in most cases observed in the setting of ischemic heart disease and often associated with advanced left ventricular (LV) impairment. Revascularization prevents negative outcomes including SCD and heart failure (HF) due to LV dysfunction (LVD). The implantable cardioverter–defibrillator (ICD) on top of medical therapy is superior to antiarrhythmic drugs for patients with LVD and VT/VF. The beneficial effects of ICD have been demonstrated in primary prevention of SCD as well. However, yet debated is the temporal management for patients with LVD who are eligible to ICD prior to revascularization, either through percutaneous or surgical approach. Restoration of coronary blood flow has a dramatic impact on adverse LV remodeling, while it requires aggressive long-term antiplatelet therapy, which might increase complication for eventual ICD procedure when percutaneous strategy is pursued; on the other hand, when LV and/or multiorgan dysfunction is present and coronary artery bypass grafting is chosen, the overall risk is augmented, mostly in HF patients. The aims of this review are to describe the pathophysiologic benefits of revascularization, the studies addressing percutaneous, surgical or no revascularization and ICD implantation, as well as emerging defibrillation strategies for patients deemed at transient risk of SCD and/or at higher risk for transvenous ICD implantation. |
| first_indexed | 2024-03-10T22:32:23Z |
| format | Article |
| id | doaj.art-ca49c7e7103347a1913f0fef8111db88 |
| institution | Directory Open Access Journal |
| issn | 2075-1729 |
| language | English |
| last_indexed | 2024-03-10T22:32:23Z |
| publishDate | 2023-09-01 |
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| record_format | Article |
| series | Life |
| spelling | doaj.art-ca49c7e7103347a1913f0fef8111db882023-11-19T11:38:26ZengMDPI AGLife2075-17292023-09-01139194010.3390/life13091940Revascularization and Left Ventricular Dysfunction for ICD EligibilityLetizia Rosa Romano0Carmen Anna Maria Spaccarotella1Ciro Indolfi2Antonio Curcio3Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, ItalyDivision of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, 80134 Naples, ItalyDivision of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, ItalyDivision of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, ItalyCommon triggers for sudden cardiac death (SCD) are transient ischemia, hemodynamic fluctuations, neurocardiovascular influences, and environmental factors. SCD occurs rapidly when sinus rhythm degenerates into ventricular tachycardia (VT) and/or ventricular fibrillation (VF), followed by asystole. Such progressive worsening of the cardiac rhythm is in most cases observed in the setting of ischemic heart disease and often associated with advanced left ventricular (LV) impairment. Revascularization prevents negative outcomes including SCD and heart failure (HF) due to LV dysfunction (LVD). The implantable cardioverter–defibrillator (ICD) on top of medical therapy is superior to antiarrhythmic drugs for patients with LVD and VT/VF. The beneficial effects of ICD have been demonstrated in primary prevention of SCD as well. However, yet debated is the temporal management for patients with LVD who are eligible to ICD prior to revascularization, either through percutaneous or surgical approach. Restoration of coronary blood flow has a dramatic impact on adverse LV remodeling, while it requires aggressive long-term antiplatelet therapy, which might increase complication for eventual ICD procedure when percutaneous strategy is pursued; on the other hand, when LV and/or multiorgan dysfunction is present and coronary artery bypass grafting is chosen, the overall risk is augmented, mostly in HF patients. The aims of this review are to describe the pathophysiologic benefits of revascularization, the studies addressing percutaneous, surgical or no revascularization and ICD implantation, as well as emerging defibrillation strategies for patients deemed at transient risk of SCD and/or at higher risk for transvenous ICD implantation.https://www.mdpi.com/2075-1729/13/9/1940revascularizationheart failurecardiac dysfunctionimplantable cardioverter–defibrillatorischemic cardiomyopathy |
| spellingShingle | Letizia Rosa Romano Carmen Anna Maria Spaccarotella Ciro Indolfi Antonio Curcio Revascularization and Left Ventricular Dysfunction for ICD Eligibility Life revascularization heart failure cardiac dysfunction implantable cardioverter–defibrillator ischemic cardiomyopathy |
| title | Revascularization and Left Ventricular Dysfunction for ICD Eligibility |
| title_full | Revascularization and Left Ventricular Dysfunction for ICD Eligibility |
| title_fullStr | Revascularization and Left Ventricular Dysfunction for ICD Eligibility |
| title_full_unstemmed | Revascularization and Left Ventricular Dysfunction for ICD Eligibility |
| title_short | Revascularization and Left Ventricular Dysfunction for ICD Eligibility |
| title_sort | revascularization and left ventricular dysfunction for icd eligibility |
| topic | revascularization heart failure cardiac dysfunction implantable cardioverter–defibrillator ischemic cardiomyopathy |
| url | https://www.mdpi.com/2075-1729/13/9/1940 |
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