ICD implantation and arrhythmia-free survival in patients with depressed LV function following surgery for valvular heart disease

Background: Although prophylactic implantable cardioverter‐defibrillator (ICD) implantation is beneficial in patients with severe ischemic cardiomyopathy, it is unclear whether patients with cardiomyopathy due to valvular heart disease have a similar benefit. Methods: We followed 17 patients (14 men/three women, age 62 ± 13 years, left ventricular ejection fraction [LVEF] 29 ± 10%) who had nonischemic valvular cardiomyopathy, underwent valvular heart surgery (aortic valve replacement, mitral valve replacement, and/or mitral valve repair), and subsequently had an electrophysiology study (EPS), for a median of 2.8 years. These patients were compared with 34 patients with prior myocardial infarction and no significant valvular heart disease, who were matched (1:2) for age, gender, LVEF, EPS result, T‐wave alternans result, and ICD placement. Occurrence of arrhythmias was ascertained from ICD device clinic follow‐up and vital status was determined using the National Death Index. Results: There were no differences between the groups in overall survival (P = 0.24) or arrhythmia‐free survival (P = 0.38), and the 2‐year arrhythmia‐free survival was 82% for the valvular patients versus 73% for the ischemic patients. Among patients with ICDs, there was no difference between the groups in overall survival (P = 0.34), time to first appropriate ICD therapy (P = 0.54), and arrhythmia‐free survival (P = 0.51). Conclusion: Patients with valvular cardiomyopathy and residual left ventricular dysfunction following valvular surgery who underwent a tailored approach to ICD implantation had similar overall and arrhythmia‐free survival as patients with ischemic cardiomyopathy.