Survival Benefit of Implantable Cardioverter-Defibrillators in Left Ventricular Assist-Device Supported Heart Failure Patients

JOURNAL OF CARDIAC FAILURE

卷:18

Article

Refaat, Marwan M.²  Tanaka, Toshikazu¹  Kormos, Robert L.^1,3  McNamara, Dennis¹  Teuteberg, Jeffrey¹  Winowich, Steve³  London, Barry¹  Simon, Marc A.^1,4 

[1] Univ Pittsburgh, Inst Heart & Vasc, Pittsburgh, PA 15213 USA

[2] Univ Calif San Francisco, Div Cardiol, San Francisco, CA USA

[3] Univ Pittsburgh, Artificial Heart Program, Pittsburgh, PA 15213 USA

[4] Univ Pittsburgh, Dept Bioengn, Pittsburgh, PA 15213 USA

关键词: Implantable cardioverter defibrillators;    heart failure;    ventricular assist devices;    transplantation;    ventricular arrhythmias;   

DOI  :  10.1016/j.cardfail.2011.10.020

来源: Elsevier

【 摘 要 】

Background: 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. Methods and Results: 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). Conclusions: 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. (J Cardiac Fail 2012;18:140-145)

【 授权许可】

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