The evolution and benefit of device therapy in patients listed for heart transplant.
The latest 2015 ESC Guidelines on the prevention of sudden cardiac death make a Class IIa recommendation for ICD implantation in patients listed for heart transplantation. This recommendation was based on expert consensus in view of the sparsity of data.



All patients listed for heart transplantation at the University Hospitals of Leuven from 2002 until 2014 were studied retrospectively. Exclusion criteria were age <16 years, cardiac disease other than ischaemic or dilated cardiomyopathy and re-transplantation. A total of 286 patients were included, of which 140 (49.0%) received an ICD. There was a historical increase of the time on the waiting list before transplantation (P < 0.001) together with an increase of the use of ICDs (P < 0.001) and left ventricular assist devices (LVADs) (P < 0.001). The proportion of patients reaching heart transplant remained unchanged (P = 0.700). The annual appropriate shock rate in patients with ICD was 28.0%/y on the active waiting list. Patients with ICD showed a trend to improved survival (P = 0.070). Independent predictors of mortality or removal from the transplant list because of clinical deterioration were the need for LVAD (HR 4.38, 95%CI 2.11-9.01), a history of stroke (HR 2.95, 95%CI 1.61-5.40), older age (HR 1.03, 95%CI 1.01-1.05) and a worse renal function (HR 1.15, 95%CI 1.00-1.33).



The time on the waiting list for heart transplantation significantly increased together with an increased use of device therapy in this population. The proportion of patients reaching transplant remained unchanged. This patient group is prone to life-threatening arrhythmias and the use of an ICD may improve survival.
Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium.|Department of Cardiology University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
Bert
B
Vandenberk
Department of Internal Medicine University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
Mark
M
Hinderks
Department of Cardiology University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
Gabor
G
Voros
Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium.|Department of Cardiology University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
Christophe
C
Garweg
Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium.|Department of Cardiology University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
Johan
J
Vanhaecke
Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium.|Department of Cardiology University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
Rik
R
Willems
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D001530:Belgium / Q000453:epidemiology; D009202:Cardiomyopathies / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D016208:Databases, Factual / Q000706:statistics & numerical data; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D016027:Heart Transplantation / Q000379:methods / Q000706:statistics & numerical data; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D016019:Survival Analysis; D014850:Waiting Lists