Premium
Impact of Implantable Cardioverter Defibrillators on Survival of Patients with Centrifugal Left Ventricular Assist Devices
Author(s) -
LEE WILLIAM,
TAY ANDRE,
SUBBIAH RAJESH N.,
WALKER BRUCE D.,
KUCHAR DENNIS L.,
MUTHIAH KAVITHA,
MACDONALD PETER S.,
KEOGH ANNE M.,
KOTLYAR EUGENE,
JABBOUR ANDREW,
SPRATT PHILIP,
JANSZ PAUL C.,
GRANGER EMILY,
DHITAL KUMUD,
HAYWARD CHRISTOPHER S.
Publication year - 2015
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12654
Subject(s) - medicine , ventricular assist device , implantable cardioverter defibrillator , cardiology , sudden cardiac death , heart transplantation , cohort , heart failure , population , univariate analysis , cardiac resynchronization therapy , survival rate , multivariate analysis , ejection fraction , environmental health
Background Both implantable cardioverter defibrillators (ICDs) and left ventricular assist devices (LVADs) have a positive impact on survival in the heart failure population. We sought to determine whether these positive effects on survival are additive or whether LVAD therapy supersedes ICD therapy. Method We analyzed survival data of patients implanted with nonpulsatile LVADs between October 2004 and March 2013. Survival in patients with ICDs (n = 64) was compared to those without ICDs (n = 36). Patients exited the study at the time of heart transplantation or death. Results A total of 100 patients underwent LVAD implantation during this time. Patients had a mean follow‐up time of 364 ± 295 days. Death occurred in 15 (38%) patients in the no ICD group versus 18 (30%) in the ICD group. Univariate analysis demonstrated a marginal early survival benefit at up to 1 year post‐LVAD implant in the ICD cohort; however, at time points greater than 1 year there was no statistically significant benefit in ICD therapy in LVAD patients (P = 0.56). Multivariate analysis did not show any significant predictor of survival. There were no patients who died of sudden cardiac death. There was no significant difference in the time to heart transplantation (443 days ± 251 no ICD vs 372 days ± 277 ICD, P = 0.37). Conclusion The benefit of ICD therapy in the setting of continuous flow LVAD therapy is uncertain. Although prolonged ventricular arrhythmias (VAs) may potentially impact on patient survival, LVAD therapy is beneficial in prevention of sudden cardiac death due to VAs.