{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T11:01:05Z","timestamp":1756810865003,"version":"3.37.3"},"reference-count":23,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T00:00:00Z","timestamp":1683244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Guidelines indicate primary\u2010prevention implantable cardioverter\u2010defibrillators (ICDs) for most patients with left ventricular ejection fraction (LVEF)\u2009\u2264\u200935%. Some patients' LVEFs improve during the life of their first ICD. In patients with recovered LVEF who never received appropriate ICD therapy, the utility of generator replacement upon battery depletion remains unclear. Here, we evaluate ICD therapy based on LVEF at the time of generator change, to educate shared decision\u2010making regarding whether to replace the depleted ICD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We followed patients with a primary\u2010prevention ICD who underwent generator change. Patients who received appropriate ICD therapy for ventricular tachycardia or ventricular fibrillation (VT\/VF) before generator change were excluded. The primary endpoint was appropriate ICD therapy, adjusted for the competing risk of death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 951 generator changes, 423 met inclusion criteria. During 3.4\u2009\u00b1\u20092.2 years follow\u2010up, 78 (18%) received appropriate therapy for VT\/VF. Compared to patients with recovered LVEF\u2009&gt;\u200935% (<jats:italic>n<\/jats:italic>\u2009=\u2009161 [38%]), those with LVEF\u2009\u2264\u200935% (<jats:italic>n<\/jats:italic>\u2009=\u2009262 [62%]) were more likely to require ICD therapy (<jats:italic>p<\/jats:italic>\u2009=\u2009.002; Fine\u2010Gray adjusted 5\u2010year event rates: 12.7% vs. 25.0%). Receiver operating characteristic analysis revealed the optimal LVEF cutoff for VT\/VF prediction to be 45%, the use of which further improved risk stratification (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001), with Fine\u2010Gray adjusted 5\u2010year rates 6.2% versus 25.1%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Following ICD generator change, patients with primary\u2010prevention ICDs and recovered LVEF have significantly lower risk of subsequent ventricular arrhythmias compared to those with persistent LVEF depression. Risk stratification at LVEF 45% offers significant additional negative predictive value over a 35% cutoff, without a significant loss in sensitivity. These data may be useful during shared decision\u2010making at the time of ICD generator battery depletion.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.15913","type":"journal-article","created":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T18:50:31Z","timestamp":1683312631000},"page":"1405-1414","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Risk of ventricular arrhythmias following implantable cardioverter\u2010defibrillator generator change in patients with recovered ejection fraction: Implications for shared decision\u2010making"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9251-2748","authenticated-orcid":false,"given":"Donald D.","family":"Chang","sequence":"first","affiliation":[{"name":"University of Queensland\u2013Ochsner Clinical School  New Orleans Louisiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7968-8260","authenticated-orcid":false,"given":"Peter G.","family":"Pantlin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Division of Electrophysiology Ochsner Medical Center  Louisiana New Orleans USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis A.","family":"Benn","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Division of Electrophysiology Ochsner Medical Center  Louisiana New Orleans USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Ryan Gullatt","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Division of Electrophysiology Ochsner Medical Center  Louisiana New Orleans USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael L.","family":"Bernard","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Division of Electrophysiology Ochsner Medical Center  Louisiana New Orleans USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Elise Hiltbold","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Division of Electrophysiology Ochsner Medical Center  Louisiana New Orleans USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sammy","family":"Khatib","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Division of Electrophysiology Ochsner Medical Center  Louisiana New Orleans USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Glenn M.","family":"Polin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Division of Electrophysiology Ochsner Medical Center  Louisiana New Orleans USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul A.","family":"Rogers","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Division of Electrophysiology Ochsner Medical Center  Louisiana New Orleans USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cruz","family":"Velasco\u2010Gonzalez","sequence":"additional","affiliation":[{"name":"Ochsner Health Center for Outcomes and Health Services Research  New Orleans Louisiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9637-9507","authenticated-orcid":false,"given":"Daniel P.","family":"Morin","sequence":"additional","affiliation":[{"name":"University of Queensland\u2013Ochsner Clinical School  New Orleans Louisiana USA"},{"name":"Department of Cardiology, Division of Electrophysiology Ochsner Medical Center  Louisiana New Orleans USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,5,5]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"210","article-title":"AHA\/ACC\/HRS guideline for management of patients with ventricular arrhythmias and 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