# Ventriculo-arterial (VA) coupling and fQRS as new selection criteria for primary prevention ICD placement

## TL;DR

This paper proposes using ventriculo-arterial coupling and fragmented QRS as better criteria for selecting heart failure patients for ICD implantation.

## Contribution

The paper introduces a novel combination of VA coupling and fQRS for improved risk stratification in ICD placement.

## Key findings

- LVEF is an inadequate predictor of sudden cardiac death in heart failure patients.
- VA coupling and fQRS may better identify patients who would benefit from ICD therapy.
- The proposed method could expand ICD eligibility to include patients with low and high LVEF.

## Abstract

For decades, left ventricular ejection fraction (LVEF < 35%) has been a mainstay for identifying heart failure (HF) patients most likely to benefit from an implantable cardioverter defibrillator (ICD). However, LVEF is a poor predictor of sudden cardiac death (SCD) and ignores 50% of HF patients with mildly reduced and preserved LVEF. The current international guidelines for primary prophylaxis ICD therapy are inadequate. Instead of LVEF, which is not a good measure of LV contractility or hemodynamic characterization, we hypothesize ventriculo-arterial (VA) coupling combined with fragmented QRS (fQRS) will improve risk stratification and patient suitability for an ICD. Quantifying cardiac and aortic mechanics, and predicting active arrhythmogenic substrate, from varying fQRS morphologies, may help to stratify ischemic and non-ischemic patients with different functional capacities and predisposition for lethal arrhythmias. We propose HF patients with a low physiological reserve may not benefit from ICD therapy, whereas those patients with higher reserves and extensive arrhythmogenic substrate may benefit. Our hypothesis combining VA coupling with fQRS changes has the potential to widen HF patient participation (low and high LVEF) and advance personalized medicine for HF patients at high risk of SCD.