Active Implantable cardioverter-defibrillators in Continuous-flow Left Ventricular Assist Device Recipients

Authors

Kuldeep Shah, Oakland University
Rahul Chaudhary, University of Pittsburgh Medical Center
Mohit K. Turagam, Icahn School of Medicine at Mount Sinai
Mahek Shah, Thomas Jefferson UniversityFollow
Brijesh Patel, West Virginia University Medical Center
Gregg Lanier, Westchester Medical Center, New York Medical College
Dhanunjaya Lakkireddy, Kansas City Heart Rhythm Institute and Research Foundation
Jalaj Garg, Loma Linda University Health

Document Type

Article

Publication Date

6-2021

Comments

This article is the authors’ final published version in Journal of Atrial Fibrillation, Volume 14, Issue 1, June 2021.

The published version is available here. Copyright © Shah et al.

Abstract

Introduction

Implantable cardioverter-defibrillator (ICD) in patients with heart failure with reduced ejection fraction reduces mortality secondary to malignant arrhythmias. Whether end-stage heart failure (HF) with continuous-flow left ventricular assist device (cf-LVAD) derive similar benefits remains controversial.

Methods

We performed a systematic literature review and meta-analysis of all published studies that examined the association between active ICDs and survival in advanced HF patients with cfLVAD. We searched PubMed, Medline, Embase, Ovid, and Cochrane for studies reporting the association between ICD and all-cause mortality in advanced HF patients with cfLVAD. Mantel-Haenszel risk ratio (RR) random-effects model was used to summarize data.

Results

Ten studies (9 retrospective and one prospective) with a total of 7,091 patients met inclusion criteria. There was no difference in all-cause mortality (RR 0.84, 95% CI 0.65–1.10, p=0.20, I² =62.40%), likelihood of survival to transplant (RR 1.07, 95% CI 0.98–1.17, p= 0.13, I² =0%), RV failure (RR 0.74, 95% CI 0.44–1.25, p = 0.26, I² =34%) between Active ICD and inactive/no ICD groups, respectively. Additionally, 27.5% received appropriate ICD shocks, while 9.5% received inappropriate ICD shocks. No significant difference was observed in terms of any complications between the two groups.

Conclusions

All-cause mortality, the likelihood of survival to transplant, and worsening RV failure were not significantly different between active ICD and inactive/no ICD in cf-LVAD recipients. A substantial number of patients received appropriate ICD shocks suggesting a high-arrhythmia burden. The risks and benefits of ICDs must be carefully considered in patients with cf-LVAD.

Recommended Citation

Shah, Kuldeep; Chaudhary, Rahul; Turagam, Mohit K.; Shah, Mahek; Patel, Brijesh; Lanier, Gregg; Lakkireddy, Dhanunjaya; and Garg, Jalaj, "Active Implantable cardioverter-defibrillators in Continuous-flow Left Ventricular Assist Device Recipients" (2021). Division of Cardiology Faculty Papers. Paper 92.
https://jdc.jefferson.edu/cardiologyfp/92

Creative Commons License

This work is licensed under a Creative Commons Attribution 3.0 License.

Language

English