Implantable cardioverter-defibrillator and cardiac resynchronization therapy in patients with left ventricular noncompaction

Background: Patients with left ventricular noncompaction (LVNC) have an increased risk for life-threatening ventricular arrhythmias. The benefit from implantable cardioverter-defibrillators (ICD) in these patients has been investigated only in small series. Therefore, the aim of the present study was to analyze the clinical outcome of a larger population of patients with LVNC who were treated with an ICD.

Methods: Thirty patients (mean age 48 ± 14) with LVNC who underwent ICD implantation for secondary (n = 12) or primary (n = 18) prevention were included in the study. The mean follow-up period was 40 ± 34 months.

Results: During follow-up, 11 patients (37%) presented with appropriate ICD therapies: three with antitachycardia pacing, four with ICD shocks, and four with both antitachycardia pacing and ICD shocks. Of these 11 patients, five received the ICD for secondary prevention and six for primary prevention. In six patients, in whom a biventricular ICD was implanted, functional New York Heart Association (NYHA) class improved from 2.5 ± 0.5 to 1.6 ± 0.8.

Conclusions: In the present study, with the largest cohort of LVNC patients with ICD to date, we demonstrate that such therapy is effective in these patients with an indication for secondary or primary prevention of sudden cardiac death. However, no clinical predictors for appropriate ICD therapy could have been elaborated in these patients. Cardiac resynchronization therapy improves functional NYHA class in patients with LVNC and may hence be considered in patients with a left ventricular ejection fraction ≤35% and signs of ventricular dyssynchrony.