Improved survival among ventricular assist device recipients with a concomitant implantable cardioverter-defibrillator

Daniel J. Cantillon, Khaldoun G. Tarakji, Dharam J. Kumbhani, Nicholas G. Smedira, Randall C. Starling, Bruce L. Wilkoff

Research output: Contribution to journalArticlepeer-review

96 Scopus citations

Abstract

Background: Ventricular tachyarrhythmia events (VTE) are common among refractory heart failure patients requiring ventricular assist device (VAD) support. It is unknown whether implantable cardioverter-defibrillator (ICD) detection and therapy can extend survival in the VAD population. Objective: The purpose of this study was to evaluate the survival experience of refractory heart failure patients requiring VAD support with and without a concomitant ICD. Methods: Multivariable analysis of the Cleveland Clinic registry of consecutive patients with and without an ICD who underwent VAD placement between 1991 and 2008 using traditional and propensity-matched methods. The primary endpoint was all-cause mortality. Results: Among 478 VAD recipients (age 53.5 ± 12.0 years, 80% male), 90 patients (18.8%) had an ICD at the time of VAD placement. VTE occurred in 26 patients (28.9%) at a mean of 32.4 ± 47.1 days, with appropriate treatment in 24 patients (75% initial shock, 25% successful antitachycardia pacing). A concomitant ICD during VAD support was associated with a significant reduction in mortality (hazard ratio [HR] 0.55 [confidence interval 0.32-0.94]; P = .028) after adjustment for age, gender, left ventricular ejection fraction, VAD type, year placed, diagnosis and duration, complications, dialysis-dependent renal failure, and extended survival (median survival 295 vs. 226 days; P = .024). A propensity-matched analysis of 134 patients with and without ICD also demonstrated that a concomitant ICD was associated with lower all-cause mortality (odds ratio 0.42 [confidence interval 0.19-0.95]; P = .04). Conclusion: A concomitant ICD among VAD recipients is associated with extended survival.

Original languageEnglish (US)
Pages (from-to)466-471
Number of pages6
JournalHeart Rhythm
Volume7
Issue number4
DOIs
StatePublished - Apr 1 2010

Keywords

  • Implantable cardioverter-defibrillator
  • Ventricular assist device
  • Ventricular tachyarrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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