Journal article
Survival Benefit of Implantable Cardioverter-Defibrillators in Left Ventricular Assist Device–Supported Heart Failure Patients
Journal of cardiac failure, Vol.18(2), pp.140-145
02/2012
DOI: 10.1016/j.cardfail.2011.10.020
PMCID: PMC3272629
PMID: 22300782
Abstract
Implantable cardioverter-defibrillators (ICDs) reduce mortality in heart failure (HF). In patients requiring a ventricular assist device (VAD), the benefit from ICD therapy is not well established. The aim of this study was to define the impact of ICD on outcomes in VAD-supported patients.
We reviewed data for consecutive adult HF patients receiving VAD as a bridge to transplantation from 1996 to 2003. The primary outcome was survival to transplantation. A total of 144 VADs were implanted [85 left ventricular (LVAD), 59 biventricular (BIVAD), mean age 50 ± 12 years, 77% male, left ventricular ejection fraction 18 ± 9%, 54% ischemic]. Mean length of support was 119 days (range 1–670); 103 patients (72%) survived to transplantation. Forty-five patients had an ICD (33 LVAD, 12 BIVAD). More LVAD patients had an appropriate ICD shock before implantation than after (16 vs 7; P = .02). There was a trend toward higher shock frequency before LVAD implant than after (3.3 ± 5.2 vs 1.1 ± 3.8 shocks/y; P = .06). Mean time to first shock after VAD implant was 129 ± 109 days. LVAD-supported patients with an ICD were significantly more likely to survive to transplantation [1-y actuarial survival to transplantation: LVAD: 91% with ICD vs 57% without ICD (log-rank P = .01); BIVAD: 54% vs 47% (log-rank P = NS)]. An ICD was associated with significantly increased survival in a multivariate model controlling for confounding variables (odds ratio 2.54, 95% confidence interval 1.04–6.21; P = .04).
Shock frequency decreases after VAD implantation, likely owing to ventricular unloading, but appropriate ICD shocks still occur in 21% of patients. An ICD is associated with improved survival in LVAD-supported HF patients.
Details
- Title: Subtitle
- Survival Benefit of Implantable Cardioverter-Defibrillators in Left Ventricular Assist Device–Supported Heart Failure Patients
- Creators
- Marwan M Refaat - Division of Cardiology, University of California, San Francisco, CaliforniaToshikazu Tanaka - Heart & Vascular Institute, University of Pittsburgh, Pittsburgh, PennsylvaniaRobert L Kormos - Heart & Vascular Institute, University of Pittsburgh, Pittsburgh, PennsylvaniaDennis Mcnamara - Heart & Vascular Institute, University of Pittsburgh, Pittsburgh, PennsylvaniaJeffrey Teuteberg - Heart & Vascular Institute, University of Pittsburgh, Pittsburgh, PennsylvaniaSteve Winowich - Artificial Heart Program, University of Pittsburgh, Pittsburgh, PennsylvaniaBarry London - Heart & Vascular Institute, University of Pittsburgh, Pittsburgh, PennsylvaniaMarc A Simon - Heart & Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
- Resource Type
- Journal article
- Publication Details
- Journal of cardiac failure, Vol.18(2), pp.140-145
- DOI
- 10.1016/j.cardfail.2011.10.020
- PMID
- 22300782
- PMCID
- PMC3272629
- NLM abbreviation
- J Card Fail
- ISSN
- 1071-9164
- eISSN
- 1532-8414
- Publisher
- Elsevier Inc
- Grant note
- KL2 RR024154; R01 HL75038; K24 HL69912; R01 HL062300; R01 HL077398 / Heart Lung and Blood Institute awards
- Language
- English
- Date published
- 02/2012
- Academic Unit
- Molecular Physiology and Biophysics; Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984025426002771
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