TY - JOUR
T1 - Improved survival among ventricular assist device recipients with a concomitant implantable cardioverter-defibrillator
AU - Cantillon, Daniel J.
AU - Tarakji, Khaldoun G.
AU - Kumbhani, Dharam J.
AU - Smedira, Nicholas G.
AU - Starling, Randall C.
AU - Wilkoff, Bruce L.
PY - 2010/4/1
Y1 - 2010/4/1
N2 - 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.
AB - 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.
KW - Implantable cardioverter-defibrillator
KW - Ventricular assist device
KW - Ventricular tachyarrhythmias
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U2 - 10.1016/j.hrthm.2009.12.022
DO - 10.1016/j.hrthm.2009.12.022
M3 - Article
C2 - 20178869
AN - SCOPUS:77949450625
SN - 1547-5271
VL - 7
SP - 466
EP - 471
JO - Heart Rhythm
JF - Heart Rhythm
IS - 4
ER -