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

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• 作者：Marwan M. Refaat ; MD¹ ; Toshikazu Tanaka ; MD² ; Robert L. Kormos ; MD² ; ³ ; Dennis Mcnamara ; MD² ; Jeffrey Teuteberg ; MD² ; Steve Winowich ; BSChE³ ; Barry London ; MD ; PhD² ; Marc A. Simon ; MD ; MS² ; ⁴ ; ^{simoma@upmc.edu}
• 关键词：Implantable cardioverter defibrillators ; heart failure ; ventricular assist devices ; transplantation ; ventricular arrhythmias
• 刊名：Journal of Cardiac Failure
• 出版年：2012
• 出版时间：February 2012
• 年：2012
• 卷：18
• 期：2
• 页码：140-145
• 全文大小：158 K

文摘

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 ¡À 12 years, 77 % male, left ventricular ejection fraction 18 ¡À 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 ¡À 5.2 vs 1.1 ¡À 3.8 shocks/y; P?= .06). Mean time to first shock after VAD implant was 129 ¡À 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.