Impact of Implantable Cardioverter Defibrillators on Survival of Patients with Centrifugal Left Ventricular Assist Devices.
BACKGROUND
Both implantable cardioverter defibrillators (ICDs) and left ventricular assist devices (LVADs) have a positive impact on survival in the heart failure population. We sought to determine whether these positive effects on survival are additive or whether LVAD therapy supersedes ICD therapy.


METHODS
We analyzed survival data of patients implanted with nonpulsatile LVADs between October 2004 and March 2013. Survival in patients with ICDs (n = 64) was compared to those without ICDs (n = 36). Patients exited the study at the time of heart transplantation or death.


RESULTS
A total of 100 patients underwent LVAD implantation during this time. Patients had a mean follow-up time of 364 ± 295 days. Death occurred in 15 (38%) patients in the no ICD group versus 18 (30%) in the ICD group. Univariate analysis demonstrated a marginal early survival benefit at up to 1 year post-LVAD implant in the ICD cohort; however, at time points greater than 1 year there was no statistically significant benefit in ICD therapy in LVAD patients (P = 0.56). Multivariate analysis did not show any significant predictor of survival. There were no patients who died of sudden cardiac death. There was no significant difference in the time to heart transplantation (443 days ± 251 no ICD vs 372 days ± 277 ICD, P = 0.37).


CONCLUSIONS
The benefit of ICD therapy in the setting of continuous flow LVAD therapy is uncertain. Although prolonged ventricular arrhythmias (VAs) may potentially impact on patient survival, LVAD therapy is beneficial in prevention of sudden cardiac death due to VAs.
Cardiology Department, St. Vincent's Hospital, Sydney, Australia.
William
W
Lee
Cardiology Department, St. Vincent's Hospital, Sydney, Australia.
Andre
A
Tay
Cardiology Department, St. Vincent's Hospital, Sydney, Australia.
Rajesh N
RN
Subbiah
Cardiology Department, St. Vincent's Hospital, Sydney, Australia.
Bruce D
BD
Walker
Cardiology Department, St. Vincent's Hospital, Sydney, Australia.
Dennis L
DL
Kuchar
Cardiology Department, St. Vincent's Hospital, Sydney, Australia.
Kavitha
K
Muthiah
Cardiology Department, St. Vincent's Hospital, Sydney, Australia.
Peter S
PS
Macdonald
Cardiology Department, St. Vincent's Hospital, Sydney, Australia.
Anne M
AM
Keogh
Cardiology Department, St. Vincent's Hospital, Sydney, Australia.
Eugene
E
Kotlyar
Cardiology Department, St. Vincent's Hospital, Sydney, Australia.
Andrew
A
Jabbour
Cardiothoracic Surgery Department, St. Vincent's Hospital, Sydney, Australia.
Philip
P
Spratt
Cardiothoracic Surgery Department, St. Vincent's Hospital, Sydney, Australia.
Paul C
PC
Jansz
Cardiothoracic Surgery Department, St. Vincent's Hospital, Sydney, Australia.
Emily
E
Granger
Cardiothoracic Surgery Department, St. Vincent's Hospital, Sydney, Australia.
Kumud
K
Dhital
Cardiology Department, St. Vincent's Hospital, Sydney, Australia.
Christopher S
CS
Hayward
D000328:Adult; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate
VT; congestive heart failure; defibrillation - ICD; heart transplantation