This protocol applies to patients with dilated cardiomyopathy (DCM) who do not carry a genotype associated with high sudden cardiac death (SCD) risk and whose left ventricular ejection fraction (LVEF) is greater than 35% — yet who present with at least one additional marker of elevated risk.
The absence of a high-risk genotype and a relatively preserved ejection fraction do not fully exclude meaningful SCD risk in DCM. Specific clinical findings identify a subgroup that warrants further evaluation:
Additional risk factors (either of the following): Unexplained syncope (loss of consciousness) — or — late gadolinium enhancement (LGE) identified on cardiac magnetic resonance (CMR) imaging.
In patients meeting these criteria, an implantable device intervention may be considered. The full candidacy framework and decision pathway are available in the complete protocol below.
DOI: 10.1093/eurheartj/ehad194
An ICD may be considered in patients with DCM without a genotype associated with high SCD risk and LVEF >35% in the presence of additional risk factors.
Additional risk factors include syncope, LGE presence on CMR.
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