Advances in pharmacological therapy in reduced left ventricular heart failure patients with implantable cardiac defibrillator and cardiac resynchronization

cardiac death (SCD) is a major cause of death in reduced left ventricular ejection fraction heart failure (rEFHF). Implantable cardiac defibrillator (ICD) significantly reduces SCD in rEFHF. Optimal heart failure medical therapy, including the blockage of renin-angiotensin system (ACEI or ARB), aldosterone system (MRA) or adrenergic system (BBK), has also proven to reduce SCD in these patients. Promisingly, a combined angiotensin receptor and neprilysin inhibition (ARNI) as compared to ACEI has demonstrated to further decrease SCD in rEFHF (by 22%). The decrease of myocardial wall tension induced by ARNI leads to a reduction in cardiac remodeling, fibrosis and repolarization dispersion, all major markers for ventricular arrhythmias. Therefore, ICD plus pharmacological therapy with ARNI, BBK and MRA are complementary tools to combat SCD.