Improved survival among ventricular assist device recipients with a concomitant implantable cardioverter-defibrillator.
BACKGROUND
Ventricular tachyarrhythmia events (VTE) are common among refractory heart failure patients requiring ventricular assist device (VAD) support. It is unknown whether implantable cardioverter-defibrillator (ICD) detection and therapy can extend survival in the VAD population.


OBJECTIVE
The purpose of this study was to evaluate the survival experience of refractory heart failure patients requiring VAD support with and without a concomitant ICD.


METHODS
Multivariable analysis of the Cleveland Clinic registry of consecutive patients with and without an ICD who underwent VAD placement between 1991 and 2008 using traditional and propensity-matched methods. The primary endpoint was all-cause mortality.


RESULTS
Among 478 VAD recipients (age 53.5 +/- 12.0 years, 80% male), 90 patients (18.8%) had an ICD at the time of VAD placement. VTE occurred in 26 patients (28.9%) at a mean of 32.4 +/- 47.1 days, with appropriate treatment in 24 patients (75% initial shock, 25% successful antitachycardia pacing). A concomitant ICD during VAD support was associated with a significant reduction in mortality (hazard ratio [HR] 0.55 [confidence interval 0.32-0.94]; P = .028) after adjustment for age, gender, left ventricular ejection fraction, VAD type, year placed, diagnosis and duration, complications, dialysis-dependent renal failure, and extended survival (median survival 295 vs. 226 days; P = .024). A propensity-matched analysis of 134 patients with and without ICD also demonstrated that a concomitant ICD was associated with lower all-cause mortality (odds ratio 0.42 [confidence interval 0.19-0.95]; P = .04).


CONCLUSIONS
A concomitant ICD among VAD recipients is associated with extended survival.
Cantillon
Daniel J
DJ
Cleveland Clinic, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland, Ohio 44195, USA. cantild@ccf.org
Tarakji
Khaldoun G
KG
Kumbhani
Dharam J
DJ
Smedira
Nicholas G
NG
Starling
Randall C
RC
Wilkoff
Bruce L
BL
D000328:Adult; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000401:mortality / Q000601:surgery*