Say no to primary prophylaxis with implantable cardioverter-defibrillators in asymptomatic nonischemic dilated cardiomyopathy?

Nonischemic dilated cardiomyopathy (NIDCM) is a common cause of congestive heart failure (CHF) and is a risk factor for sudden cardiac death (1,2). Although an asymptomatic patient with ischemic cardiomyopathy can now be approached with a reasonably established strategy (e.g., risk stratification using an electrophysiologic [EP] study in those with moderately reduced left ventricular [LV] function and non-sustained ventricular tachycardia [NSVT] [3]; a prophylactic implantable cardioverter-defibrillator [ICD] in those with severely reduced LV function [4]), the optimal management of asymptomatic patients with NIDCM has been less rigorously defined.