Treatment of Dilated Cardiomyopathy with a High Sudden Cardiac Death Risk Genotype and Left Ventricular Ejection Fraction >35%

Clinical Scenario

This protocol addresses a selected subset of dilated cardiomyopathy patients who carry a genotype associated with high sudden cardiac death (SCD) risk, yet retain a left ventricular ejection fraction above 35%.

        Critically, these patients present without the additional risk factors that would otherwise escalate risk: there is no history of syncope and no late gadolinium enhancement (LGE) detected on cardiac magnetic resonance (CMR) imaging.
      

Why Genotype Matters Here

In this population, the underlying genetic profile — rather than the degree of systolic dysfunction alone — drives the elevated SCD risk. The absence of syncope and LGE on CMR defines a specific intermediate-risk subgroup where the approach to arrhythmic risk management differs from standard LVEF-based thresholds.

Treatment Approach (Partial Overview)

In selected patients meeting these criteria, a device-based intervention for arrhythmic protection may be considered. The full structured protocol specifies the precise indication, eligibility criteria, and implementation guidance.

Complete regimen details, indication thresholds, and clinical decision pathway are available in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehad194

An ICD may be considered in selected patients with DCM with a genotype associated with high SCD risk and LVEF >35% without additional risk factors (see Table 21).

Additional risk factors include syncope, LGE presence on CMR.

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