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Implantable Cardioverter Defibrillators in Patients With Continuous Flow Left Ventricular Assist Devices: Utilization

Paulino A Alvarez1,2, Brett W Sperry1,3, Antonio L Pérez1

  • 11 Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland OH.

Journal of the American Heart Association
|July 9, 2019
PubMed

Insights

Implantable cardioverter defibrillators (ICDs) do not appear to improve survival in patients with left ventricular assist devices (LVADs). The study found no mortality benefit, despite significant ICD-related complications and procedures in LVAD patients.

Area of Science:

  • Cardiology
  • Medical Devices
  • Clinical Outcomes

Background:

  • The impact of implantable cardioverter defibrillators (ICDs) on outcomes in patients with continuous flow left ventricular assist devices (LVADs) lacks randomized clinical trial data.
  • This study addresses the clinical utility of ICDs in the LVAD population.

Purpose of the Study:

  • To evaluate the association between pre-existing implantable cardioverter defibrillators (ICDs) and outcomes in patients with continuous flow left ventricular assist devices (LVADs).
  • To assess the mortality benefit and morbidity associated with ICDs in LVAD recipients.

Main Methods:

  • Retrospective single-center study of 486 patients undergoing continuous flow LVAD implantation (October 2004 - March 2017).
  • Patients were analyzed based on the presence or absence of an ICD at the time of LVAD insertion.
  • Multivariable analysis and time-varying covariate analysis were used to assess mortality risk.

Main Results:

  • Of 486 patients, 387 (79.6%) had a pre-LVAD ICD. Patients with ICDs were older and had fewer pre-LVAD interventions.
  • 81 patients (21.4% of those with ICDs) required 93 procedures post-LVAD (generator exchanges, lead revisions, system removals).
  • The presence of a pre-LVAD ICD was not significantly associated with mortality (HR 1.19, P=0.492), nor was an ICD analyzed as a time-varying covariate (HR 1.05, P=0.907).

Conclusions:

  • There is no apparent mortality benefit of having an implantable cardioverter defibrillator (ICD) in contemporary patients with continuous flow left ventricular assist devices (LVADs).
  • The potential morbidity from ICD-related procedures and complications may outweigh any survival advantage in this patient population.

Keywords:
implanted cardioverter defibrillatorinfectionleft ventricular assist device

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