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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Implantable cardioverter defibrillator for primary prevention in patients with severe ventricular dysfunction
E M Cantero-Pérez1, J M Sobrino-Márquez, A Grande-Trillo
1Department of Cardiology, Heart Area, Clinical Management Unit, Virgen del Rocío University Hospital, Seville, Spain.
Insights
Implantable cardioverter defibrillators (ICDs) may reduce sudden cardiac death risk for patients awaiting heart transplants. This study found lower mortality in patients receiving ICDs, though further research is needed.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Devices
Background:
- Increasing end-stage heart failure patients and decreasing donor acceptance rates lead to longer transplant wait times.
- Higher rates of emergency heart transplants increase the risk of sudden death for elective candidates.
- Indications for implantable cardioverter defibrillators (ICDs) in this high-risk population are not well-established.
Purpose of the Study:
- To evaluate the effectiveness of ICDs for primary prevention in heart transplant candidates with a left ventricular ejection fraction (LVEF) ≤ 30%.
Main Methods:
- Retrospective review of heart transplant candidates with LVEF <31% between 2006 and 2012.
- Comparison of outcomes between patients who received ICDs (n=28) and those who did not (n=51).
- Statistical analyses included descriptive statistics, chi-squared tests, t-tests, and Kaplan-Meier survival curves.
Main Results:
- Overall mortality was lower in the ICD group (7.1%) compared to the non-ICD group (17.6%; P=.062).
- Sudden death was the primary cause of mortality in the non-ICD group (55.6%), while heart failure was the only reported cause of death in the ICD group.
- Appropriate ICD therapies were delivered in 42.9% of patients in the ICD group.
Conclusions:
- ICDs may reduce the risk of sudden cardiac death in patients awaiting heart transplantation with LVEF ≤ 30%.
- Further studies are necessary to confirm these findings and establish definitive indications for ICD use in this patient cohort.
Background:
Despite an increase in patients with end-stage heart failure, the acceptance rate has been going down in recent years owing to a change in donor demographics. Furthermore, the rate of emergency heart transplantation has progressively increased. The result is an increase in the time awaiting heart transplantation in elective patients and therefore in the risk of sudden death in this population. Implantable cardioverter defibrillators (ICDs) could be a preventive option in these cases. However, indications for the implantation in this population are not well established.
Objective:
We sought to evaluate the effectiveness of ICDs for primary prevention in patients with left ventricular ejection fraction (LVEF) ≤ 30% included on the heart transplantation list.
Methods:
Records from patients accepted for heart transplantation in our institution from January 1, 2006, to July 30, 2012, and whose LVEF was <31% were reviewed. Patients who received ICDs for primary prevention (n = 28) were compared with patients without ICDs (n = 51). Descriptive and univariate (χ(2) and t tests) statistics and Kaplan-Meier survival curves were used for analyses.
Results:
With a median follow-up of 77 days (range 1-1,231), the overall mortality in the ICD group was 7.1% (2/28) and in the non-ICD group was 17.6% (9/51; P = .062). The main cause of death in patients without ICDs was sudden death (5/9, 55.6%), followed by heart failure (4/9, 44.4%). In patients with ICDs, heart failure was the only reported cause of death. Appropriate ICD therapies were recorded in 42.9% (12/28) in this population.
Conclusions:
This study suggests that ICD could reduce the risk of sudden death in patients with LVEF ≤ 30% while awaiting heart transplantation. However, more studies are needed to confirm these results.
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