title: Implantable cardioverter-defibrillators in end-stage heart failure patients listed for heart transplantation: Results from a large retrospective registry.
abstract: BACKGROUND
  Implantable cardioverter-defibrillators (ICDs) are recommended in patients with low ejection fraction. However, the survival benefit of ICDs in patients with end-stage heart failure listed for heart transplantation is unclear.
  
  
  OBJECTIVE
  To evaluate the ICD benefit on mortality in this population.
  
  
  METHODS
  Three hundred and eighty consecutive patients listed for heart transplantation between 2005 and 2009 in one tertiary heart transplant centre were enrolled in a retrospective registry; 122 patients received an ICD before or within 3 months after being listed for heart transplantation (ICD group). Predictors of death on the waiting list were assessed by Cox regression.
  
  
  RESULTS
  Overall, 15.6% of patients died while awaiting heart transplantation. Non-ICD patients presented more often haemodynamic compromise requiring mechanical circulatory support (29.1% vs. 9.8%; P<0.001), and were more likely to die while on the waiting list (19.0% vs. 8.3%; log-rank P=0.001). However, in the multivariable model, ICD did not remain an independent predictor of death. Need for mechanical circulatory support (P<0.001), low ejection fraction (P=0.001) and registration on the regular list (P=0.008) were the only independent predictors of death. Death was mainly caused by haemodynamic compromise (76.3% of deaths), which occurred more frequently in the non-ICD group (14.7% vs. 5.8%; log-rank P=0.002). Unknown/arrhythmic deaths did not differ significantly between the two groups (3.9% vs. 1.7%; log-rank P=0.21). ICD-related complications occurred in 21.4% of patients, mainly as a result of postoperative worsening of heart failure (11.9%).
  
  
  CONCLUSIONS
  Haemodynamic failure appears as the main determinant of mortality in patients with end-stage heart failure awaiting heart transplantation. ICD seems to have little benefit on survival in this population.
authors.affiliation: Département de Cardiologie, AP-HP, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France. Electronic address: estelle.gandjbakhch@aphp.fr.
authors.forename: Estelle
authors.initials: E
authors.lastname: Gandjbakhch
authors.affiliation: Département de Cardiologie, Hôpital Saint-Joseph, 75015 Paris, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Rovani
authors.affiliation: Département de Chirurgie Cardiaque, AP-HP, Hôpital Pitié-Salpêtrière, 75013 Paris, France.
authors.forename: Shaida
authors.initials: S
authors.lastname: Varnous
authors.affiliation: Département de Cardiologie, AP-HP, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Maupain
authors.affiliation: Département de Cardiologie, AP-HP, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Chastre
authors.affiliation: Département de Cardiologie, AP-HP, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Waintraub
authors.affiliation: Département de Cardiologie, AP-HP, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Pousset
authors.affiliation: Département de Chirurgie Cardiaque, AP-HP, Hôpital Pitié-Salpêtrière, 75013 Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lebreton
authors.affiliation: Département de Cardiologie, AP-HP, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Duthoit
authors.affiliation: Département de Cardiologie, AP-HP, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Badenco
authors.affiliation: Département de Cardiologie, AP-HP, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Himbert
authors.affiliation: Département de Chirurgie Cardiaque, AP-HP, Hôpital Pitié-Salpêtrière, 75013 Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.affiliation: Département de Cardiologie, AP-HP, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Hidden-Lucet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult
keywords: Défibrillateur implantable; Heart failure; Heart transplantation; Implantable cardioverter-defibrillator; Insuffisance cardiaque; Transplantation cardiaque