The efficacy of implantable cardioverter-defibrillators in heart transplant recipients: results from a multicenter registry.
BACKGROUND
Sudden cardiac death among orthotopic heart transplant recipients is an important mechanism of death after cardiac transplantation. The role for implantable cardioverter-defibrillators (ICDs) in this population is not well established. This study sought to determine whether ICDs are effective in preventing sudden cardiac death in high-risk heart transplant recipients.


RESULTS
We retrospectively analyzed the records of all orthotopic heart transplant patients who had ICD implantation between January 1995 and December 2005 at 5 heart transplant centers. Thirty-six patients were considered high risk for sudden cardiac death. The mean age at orthotopic heart transplant was 44+/-14 years, the majority being male (n=29). The mean age at ICD implantation was 52+/-14 years, whereas the average time from orthotopic heart transplant to ICD implant was 8 years +/-6 years. The main indications for ICD implantation were severe allograft vasculopathy (n=12), unexplained syncope (n=9), history of cardiac arrest (n=8), and severe left ventricular dysfunction (n=7). Twenty-two shocks were delivered to 10 patients (28%), of whom 8 (80%) received 12 appropriate shocks for either rapid ventricular tachycardia or ventricular fibrillation. The shocks were effective in terminating the ventricular arrhythmias in all cases. Three (8%) patients received 10 inappropriate shocks. Underlying allograft vasculopathy was present in 100% (8 of 8) of patients who received appropriate ICD therapy.


CONCLUSIONS
Use of ICDs after heart transplantation may be appropriate in selected high-risk patients. Further studies are needed to establish an appropriate prevention strategy in this population.
Tsai
Vivian W
VW
Division of Cardiovascular Medicine, Stanford University, Stanford, Calif, USA. vtsai@stanfordalumni.org
Cooper
Joshua
J
Garan
Hasan
H
Natale
Andrea
A
Ptaszek
Leon M
LM
Ellinor
Patrick T
PT
Hickey
Kathleen
K
Downey
Ross
R
Zei
Paul
P
Hsia
Henry
H
Wang
Paul
P
Hunt
Sharon
S
Haddad
François
F
Al-Ahmad
Amin
A
D000328:Adult; D050197:Atherosclerosis / Q000209:etiology / Q000628:therapy; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy; D006331:Heart Diseases / Q000209:etiology / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D013575:Syncope / Q000209:etiology / Q000628:therapy; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000628:therapy; D014693:Ventricular Fibrillation / Q000209:etiology / Q000628:therapy*