Are Primary Prevention ICDs Needed in ALL Patients with Reduced EF?-Are Primary Prevention ICDs Needed in ALL Patients with Reduced EF?

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Video Summary

In this engaging debate session, experts Sanal Khadib, Gert Hendricks, and Ilan Goldenberg discussed the necessity of primary prevention ICDs (Implantable Cardioverter-Defibrillators) for patients with reduced ejection fraction, a key indicator of heart failure severity. Each expert presented their stance on whether all patients with low ejection fraction should receive ICDs. <br /><br />Dr. Sanal Khadib advocated for ICD use, citing strong evidence from major clinical trials such as MAIDER-2 and SCADHF, which demonstrated significant reductions in mortality among ICD recipients. Despite acknowledging the improved medical therapies available today, Khadib emphasized the substantial survival benefits ICDs offer, particularly due to the risk of sudden cardiac death that persists even with advanced heart failure medications.<br /><br />Conversely, Professor Gert Hendricks challenged the continued routine use of ICDs, arguing that the foundational trials like MAIDER-2 are outdated given the advancements in heart failure management over the past decades. He suggested that with improved medical therapies now significantly reducing mortality, including sudden cardiac death, the role of ICDs should be reevaluated through fresh, large-scale trials focused on contemporary patients.<br /><br />Dr. Ilan Goldenberg discussed the need for risk stratification before deciding on ICD implantation, highlighting that the benefits of ICDs should be weighed against the potential risks and complications such as inappropriate shocks and infections. He pointed out that current trials, like Contemp-ICD and Profit Era, are essential to updating guidelines with more relevant data.<br /><br />Given the complex considerations, such as patient comorbidities and evolving medical therapies, the debate highlighted a critical need for updated clinical trials and guidelines to support personalized patient care.

Keywords

ICD

heart failure

ejection fraction

Sanal Khadib

Gert Hendricks

Ilan Goldenberg

MAIDER-2

SCADHF

Contemp-ICD

risk stratification