title: Primary preventive cardioverter-defibrillator implantation (Pro-ICD) in patients awaiting heart transplantation. A prospective, randomized, controlled 12-year follow-up study.
abstract: The aim of this study was to evaluate whether short-term primary preventive cardioverter-defibrillator (ICD) implantation as bridge to heart transplantation (HTX) provides any survival benefit. Thirty-three patients awaiting HTX were randomized to either conventional therapy (control group) or primary preventive ICD implantation (ICD group). Fourteen patients had ischemic cardiomyopathy (ICM) and 19 patients had dilated cardiomyopathy (DCM). Sixteen patients were randomized to the ICD group and 17 patients were randomized to the control group. Twenty patients (61%) were transplanted after a waiting time of 10 ± 9 months. The remaining 13 patients (39%) were not transplanted because of clinical improvement (n = 5), cerebral hemorrhage (n = 3), or death (n = 5). On the waiting list, 3 ICD patients with DCM developed slow VTs without ICD intervention, two patients with ICM (6%) had fast VT terminated by the ICD, and no arrhythmic death was observed. After 11.9 years (median), 13 of 20 HTX patients (65%) and 5 of 13 non-HTX patients (38%) were alive. Survivors had a higher LVEF (22 ± 6 vs. 17 ± 4%, P = 0.0092) and a better exercise capacity (75 ± 29 vs. 57 ± 24 Watt, P = 0.0566) at baseline as compared to nonsurvivors. This study may not support the general use of primary preventive ICDs as a short-term bridge to heart transplantation.
authors.affiliation: Department of Internal Medicine II, Devision of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pezawas
authors.forename: Michael
authors.initials: M
authors.lastname: Grimm
authors.forename: Robin
authors.initials: R
authors.lastname: Ristl
authors.forename: Danijel
authors.initials: D
authors.lastname: Kivaranovic
authors.forename: Fabian T
authors.initials: FT
authors.lastname: Moser
authors.forename: Guenther
authors.initials: G
authors.lastname: Laufer
authors.forename: Herwig
authors.initials: H
authors.lastname: Schmidinger
mesh_terms: D000328:Adult; D000368:Aged; D016757:Death, Sudden, Cardiac; D017147:Defibrillators, Implantable; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000601:surgery / Q000628:therapy; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome
keywords: heart transplantation; implantable cardioverter defibrillator; sudden cardiac death