Implantable Cardioverter-Defibrillator for Primary Prevention in Asia

Abstract

In a contemporary setting, where the risk of sudden cardiac death (SCD) is low, heart failure management is improved, and technology is advanced, identifying the patients who would benefit the most from an implantable cardioverter-defibrillator (ICD) treatment for primary prevention remains a challenge. The prevalence of SCD is lower in Asia when compared with the United States/Europe (35-45 per 100,000 person-years vs 55-100 per 100,000 person-years, respectively). Nevertheless, this should not explain the enormous gap in ICD's utilization among eligible candidates (∼12% in Asia vs ∼45% in the United States/Europe). The disparity between Asia and Western countries, together with significant variation among the Asian population and the previously mentioned challenges, requires an individualized approach and specific regional recommendation, especially in countries with limited resources where ICDs are being extremely underutilized This review focuses on the current knowledge of ICD therapy for SCD prevention and how to improve patient and device selection.

Keywords: Asia; ICD; implantable cardioverter-defibrillator; patient’s selection; primary prevention; risk stratification.

Graphical abstract

Figure 1

Individual and Summary Odds Ratios for All-Cause Mortality in Patients With NICM Shown is meta-analysis based on risk differences and random-effects model. Blue squares denote study-specific risk differences (with 95% CI) and the diamond indicates the pooled risk difference (with 95% CI); weight is based on the sample size; on the right are the HRs with the corresponding 95% CI. AMIOVIRT = Amiodarone vs. Implantable Defibrillator Randomized Trial; CAT = Cardiomyopathy Trial; DANISH = Danish Study to Assess the Efficacy of ICDs in Patients with Non-Ischemic Systolic Heart Failure on Mortality; DEFINITE = Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation; ICD = implantable cardioverter-defibrillator; MT = medical therapy; SCD-HeFT = Sudden Cardiac Death in Heart Failure Trial.

Central Illustration

Risk Stratification for Implantable Cardioverter-Defibrillator Insertion for Primary Prevention This figure represents a proposed algorithm (flow chart) for risk stratification and prevention of sudden cardiac death (primary prevention) for implantable cardioverter-defibrillator (ICD) candidates. First step should include assessment of the sudden cardiac death (SCD) risk and the non-SCD risk. In candidates with increased SCD risk, ICD is highly recommended, whereas in those with increased non-SCD risk, ICD might be beneficial. CKD = chronic kidney disease; CVA = cerebrovascular disease; NSVT = nonsustained ventricular tachycardia; PVD = peripheral vascular disease. ∗Infarct tissue heterogeneity assessed with contrast-enhanced magnetic resonance imaging. †BMI <23 kg/m². ^ˆSuch as commercial pilot or bus driver.