Prédicteurs de l’implantation de défibrillateur automatique implantable dans la cardiopathie ischémique avec dysfonction ventriculaire gauche sévère. Une analyse rétrospective monocentrique

Abstract

Context and objective. Patients with ischemic heart disease (IHD) and severe left ventricular dysfunction (LVD) are at high risk of sudden cardiac death (SCD). Implantable cardioverter-defibrillators (ICDs) reduce this risk but are typically considered only after reassessing left ventricular ejection fraction (LVEF) three months post-discharge. The present study aimed to identify predictors of ICD implantation in patients with IHD and severe LVD. Methods. This was a retrospective cohort study including adult patients (≥ 18 years) with IHD and LVEF < 35%, hospitalized between January 2020 and August 2024 at the Centre Hospitalier Sud Francilien (CHSF). All were discharged with a wearable cardioverter defibrillator (WCD), and reassessed after 3 months. Multivariate logistic regression was used to identify factors associated with ICD implantation. Results. Among 123 patients, 51 (41.5%) underwent ICD implantation. Factors independently associated with ICD implantation included Age ≥ 60 years, hypertension (aOR 2.52; 95% CI: 1.57–5.99), early revascularization (aOR 2.89; 95% CI: 1.82–5.34), sustained ventricular tachycardia (aOR 3.60; 95% CI: 1.97–5.23), and LVEF ≤ 20% (aOR 3.39; 95% CI: 1.92–9.38). Conclusion. In IHD patients with severe LVD, several factors may guide early identification of candidates for ICD implantation. Received: February 17th ,2025 Accepted: March 29th, 2025 https://dx.doi.org/10.4314/aamed.v18i4.5