Improved survival of cardiac transplantation candidates with implantable cardioverter defibrillator therapy: role of beta-blocker or amiodarone treatment.
BACKGROUND
Survival in patients awaiting cardiac transplantation is poor due to the severity of left ventricular dysfunction and the susceptibility to ventricular arrhythmia. The potential role of implantable cardioverter defibrillators (ICDs) in this group of patients has been the subject of increasing interest. The aims of this study were to ascertain whether ICDs improve the survival rate of patients on the waiting list for cardiac transplantation and whether any improvement is independent of concomitant beta-blocker or amiodarone therapy.


RESULTS
Data comprised findings from 310 consecutive patients at a single center who were evaluated and deemed suitable for cardiac transplantation and placed on the waiting list. Kaplan-Meier actuarial approach was used for survival analysis. Survival analysis censored patients at time of transplantation or death. Of the 310 patients, 111 (35.8%) underwent successful cardiac transplantation and 164 (52.9%) died while waiting; 35 patients remain on the waiting list. Fifty-nine (19%) patients had ICD placement for ventricular arrhythmias prior to or after being listed. Twenty-nine (49.1%) ICD patients survived until cardiac transplantation, 13 (22%) patients died, and 17 (28.8%) remain on the waiting list. Among non-ICD patients, 82 (32.7%) received transplants, 151 (60.2%) died, and 18 (7.2%) remain on the waiting list. Survival rates at 6 months and 1, 2, 3, and 4 years were better for all ICD patients compared to non-ICD patients (log-rank x2, P = 0.0001). By multivariate analysis, ICD therapy and beta-blocker treatment were the strongest predictors of survival. Further, ICD treatment was associated with improved survival independent of concomitant treatment with beta-blocker or amiodarone. Among ICD and non-ICD patients treated with a beta-blocker or amiodarone, survivals at the 1 and 4 years were 93% vs 69% and 57% vs 32%, respectively (log-rank x2, P = 0.003).


CONCLUSIONS
ICD therapy is associated with improved survival in high-risk cardiac transplant candidates, and ICD benefit appears to be independent of concomitant treatment.
Ermis
Cengiz
C
Cardiac Arrhythmia Center, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota 55436, USA.
Zadeii
Gino
G
Zhu
Alan X
AX
Fabian
William
W
Collins
Joanne
J
Lurie
Keith G
KG
Sakaguchi
Scott
S
Benditt
David G
DG
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000401:mortality / Q000628:therapy; D009202:Cardiomyopathies / Q000401:mortality / Q000628:therapy; D003131:Combined Modality Therapy / Q000401:mortality; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D000638:Amiodarone