title: The role of implantable cardioverter-defibrillators in patients with continuous flow left ventricular assist devices - A meta-analysis.
abstract: BACKGROUND
  Left ventricular assist devices (LVADs) and implantable cardioverter defibrillators (ICD) are each known to improve mortality in patients with advanced congestive heart failure (CHF). If ICDs contribute to improved survival specifically in recipients of LVADs is currently unknown.
  
  
  OBJECTIVE
  To evaluate the impact of presence of ICD on mortality in continuous flow LVAD recipients.
  
  
  METHODS
  A meta- analysis of available literature was performed. PubMed, Embase and Google Scholar databases were searched for studies that compared mortality in continuous flow LVAD patients with ICDs (new implantation or no de-activation) and without ICDs (including de-activation of existing implant). Pooled analysis using a fixed effects model was used for outcomes of interest.
  
  
  RESULTS
  We included 3 observational studies for a total of 292 patients (203 (69.5%) with ICD versus 89 (30.5%) without ICD). The presence of an active ICD was not associated with improved survival [OR 0.63, 95% CI 0.33-1.18; p=0.15]. In bridge to transplantation [BT] patients (224 patients, 149 with ICD versus 75 without ICD), an active ICD was not associated with a higher probability of survivzal [OR 1.47, 95% CI 0.78-2.76; p=0.23]. There was no difference in the occurrence of severe right ventricular dysfunction or failure between two groups [OR 0.78, 95% CI 0.42-1.47; p=0.45]. The risk of LVAD related complications were similar [OR 0.68, 95% CI 0.35-1.31; P=0.25].
  
  
  CONCLUSIONS
  This meta-analysis demonstrates that there is no survival benefit with ICD in heart failure patients supported with continuous flow LVAD. There is an urgent need of large-scale randomized trials to specifically address this issue.
authors: Division of Cardiology, Department of Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA. Electronic address: Sahilagrwal124@gmail.com.
authors: Sahil
authors: S
authors: Agrawal
authors: Department of Medicine, Beaumont Health System, Royal Oak, MI, USA.
authors: Lohit
authors: L
authors: Garg
authors: Division of Cardiology, Department of Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA.
authors: Sudip
authors: S
authors: Nanda
authors: Division of Cardiology, Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA.
authors: Abhishek
authors: A
authors: Sharma
authors: Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
authors: Nirmanmoh
authors: N
authors: Bhatia
authors: Division of Cardiology, Department of Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA.
authors: Yugandhar
authors: Y
authors: Manda
authors: Division of Cardiology, Department of Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA.
authors: Amitoj
authors: A
authors: Singh
authors: Division of Cardiology, Department of Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA.
authors: Mark
authors: M
authors: Fegley
authors: Division of Cardiology, Department of Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA.
authors: Jamshid
authors: J
authors: Shirani
mesh_terms: D017147:Defibrillators, Implantable / Q000639:trends*; D006353:Heart-Assist Devices / Q000639:trends*; D006801:Humans; D009026:Mortality / Q000639:trends; D064887:Observational Studies as Topic; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*
keywords: ICD; Implantable defibrillator; Mortality; Survival; Ventricular arrhythmia left ventricular assist device