title: Selected patients listed for cardiac transplantation may benefit from defibrillator implantation regardless of an established indication.
abstract: BACKGROUND
  End-stage heart failure (HF) patients are at high risk of sudden cardiac death. This study evaluates the role of implantable cardiac defibrillators (ICDs) in HF patients awaiting cardiac transplantation.
  
  
  METHODS
  We identified 194 consecutive patients (age 51 +/- 12 years) with New York Heart Association Class 3 or 4 HF (ejection fraction 22 +/- 9%) listed for cardiac transplantation, 35 of whom underwent ICD implantation. Of the implanted patients, 16 (Group A) had an established indication for ICD implantation (cardiac arrest, n = 10; sustained ventricular tachycardia [VT], n = 3; and positive electrophysiology study, n = 3). Nineteen patients (Group B) underwent ICD implantation for non-established indications (syncope with non-ischemic cardiomyopathy, n = 4; non-sustained VT, n = 15). There were no procedural complications from ICD implantation.
  
  
  RESULTS
  During follow-up of 9.2 +/- 10.1 months, there were 3 deaths in the ICD groups (A and B), and 40 in the control group (8.6% vs 25.2%, p = 0.032). Five patients in Group A and 6 in Group B (31%) received appropriate ICD therapy. The number of therapies per patient and the time to the first shock were similar between Groups A and B. Four of 6 Group B patients on outpatient inotropic therapy (67%) received appropriate ICD therapy.
  
  
  CONCLUSIONS
  Selected end-stage heart failure patients awaiting heart transplantation, including those without established ICD indications, are at high risk for malignant arrhythmias and may benefit from ICD implantation. Patients with ICD seem to have improved survival compared to those without ICD. Randomized prospective studies are needed to confirm these findings.
authors.affiliation: Electrophysiology Division of the Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. sabas@msx.upmc.edu
authors.forename: Samir
authors.initials: S
authors.lastname: Saba
authors.forename: Walter L
authors.initials: WL
authors.lastname: Atiga
authors.forename: William
authors.initials: W
authors.lastname: Barrington
authors.forename: Leonard I
authors.initials: LI
authors.lastname: Ganz
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kormos
authors.forename: Guy A
authors.initials: GA
authors.lastname: MacGowan
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mathier
authors.forename: Dennis M
authors.initials: DM
authors.lastname: McNamara
authors.forename: Ogundu
authors.initials: O
authors.lastname: Obioha-Ngwu
authors.forename: Srinivas
authors.initials: S
authors.lastname: Murali
mesh_terms: D000328:Adult; D016757:Death, Sudden, Cardiac / Q000209:etiology* / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014850:Waiting Lists