title: Implantable Cardioverter-Defibrillator Use in Patients With Left Ventricular Assist Devices: A Systematic Review and Meta-Analysis.
abstract: This study evaluated the impact of implantable cardioverter-defibrillators (ICDs) on mortality in patients with left ventricular assist devices (LVADs) by conducting a systematic review and meta-analysis of published studies.
  
  
  
  The burden of ventricular arrhythmias in patients with LVADs is high. Prior studies assessing the impact of ICD on survival of patients with LVADs have yielded conflicting results.
  
  
  
  Relevant studies from January 2000 through October 2015 were identified in the databases PubMed and OVID. Weighted relative risks were estimated using random effects meta-analysis techniques.
  
  
  
  Six observational studies (n = 937) were included. Patients were 53 ± 12 years of age, and 80% were male. Bridge-to-transplantation was the indication for LVAD use in 93% of the patients. A continuous-flow (CF) LVAD was present in 39% of patients. Mean left ventricular ejection fraction was 16 ± 6%. An ICD was present in 355 patients (38%). During a mean follow-up of 7 months, 241 patients (26%) died (16% in the ICD group vs. 32% in the no-ICD group). Presence of an ICD was associated with a 39% relative risk reduction in all-cause mortality (RR: 0.61; 95% confidence interval [CI]: 0.46 to 0.82; p < 0.01). Among subgroup of patients with CF-LVAD (n = 361), ICD use was associated with a statistically nonsignificant trend toward improved survival (RR: 0.76; 95% CI: 0.51 to 1.12; p = 0.17).
  
  
  
  ICD use was associated with a significant reduction in mortality in LVAD patients, however, this effect was not significant in patients with CF-LVADs. Although these data support the use of ICDs, larger randomized trial data are strongly warranted to evaluate ICD effectiveness in patients with current generation LVADs.
authors.affiliation: Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, Minnesota; Division of Cardiology, University of Minnesota, Minneapolis, Minnesota. Electronic address: vakil012@umn.edu.
authors.forename: Kairav
authors.initials: K
authors.lastname: Vakil
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Felipe
authors.initials: F
authors.lastname: Kazmirczak
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Sathnur
authors.affiliation: Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, Minnesota; Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Adabag
authors.affiliation: Division of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Cantillon
authors.affiliation: Division of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Erich L
authors.initials: EL
authors.lastname: Kiehl
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Ryan
authors.initials: R
authors.lastname: Koene
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cogswell
authors.affiliation: Division of Cardiology, Veterans Affairs Medical Center, San Diego, California.
authors.forename: Inderjit
authors.initials: I
authors.lastname: Anand
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Henri
authors.initials: H
authors.lastname: Roukoz
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications / Q000628:therapy*; D002423:Cause of Death; D017147:Defibrillators, Implantable; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D009026:Mortality; D013318:Stroke Volume
keywords: implantable cardioverter-defibrillator; left ventricular assist device; meta-analysis; mortality; systematic review