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Updated: Aug 4, 2026
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 defibrillators in patients with orthotopic heart transplant: A multicenter case series
Waddah Maskoun1, Mohamad Raad1, Yong-Mei Cha2
1Division of Electrophysiology, Department of Cardiovascular Diseases, Henry Ford Health System, Detroit, Michigan, USA.
Insights
Implantable cardioverter-defibrillators (ICDs) show benefit in heart transplant recipients, especially for secondary prevention of sudden cardiac death. Higher ejection fraction improves outcomes, and cardiac resynchronization therapy may also be beneficial.
Area of Science:
- Cardiology
- Transplant Surgery
- Electrophysiology
Background:
- Sudden cardiac death (SCD) is a significant concern following orthotopic heart transplant (OHT).
- Current guidelines for implantable cardioverter-defibrillator (ICD) implantation in high-risk OHT patients are lacking.
Purpose of the Study:
- To evaluate the safety, efficacy, and benefit of ICDs and cardiac resynchronization therapy (CRT) in OHT patients.
- To systematically review existing literature on ICDs and CRT post-OHT.
Main Methods:
- Retrospective multicenter cohort study of OHT patients who received ICDs between 2000 and 2020.
- Analysis of 16 patients from 4 US centers, examining demographics, clinical data, and outcomes.
Main Results:
- Mean age at OHT was 43 years, and at ICD implantation was 51 years, with a mean of 9 years post-OHT.
- Two complications (hematoma, death) occurred. Survival rates were 63% at 1 year and 56% at 2 years.
- ICD therapy was more effective for secondary prevention (5/8 patients) than primary prevention (0/8 patients). Patients with left ventricular ejection fraction (LVEF) <35% had higher mortality.
Conclusions:
- ICDs demonstrate beneficial outcomes in OHT patients, particularly when implanted for secondary prevention.
- Higher baseline LVEF is associated with better outcomes.
- Cardiac resynchronization therapy also showed potential benefits in this patient population.
Background:
Sudden cardiac death (SCD) is common after orthotopic heart transplant (OHT). No clear guidelines for implantable cardioverter defibrillator (ICD) implantation in OHT patients at high risk for SCD currently exist.
Objectives:
To assess the safety, efficacy, and benefit of ICDs and resynchronization therapy post-OHT. We also provide a systematic review of previous reports.
Methods:
A retrospective multicenter cohort study within the United States. Patients with ICD post-OHT between 2000 and 2020 were identified.
Results:
We analyzed 16 patients from 4 centers. The mean standard-deviation (SD) age was 43 (18) years at OHT and 51 (20) years at ICD implantation. The mean (SD) duration from OHT to ICD implantation was 9 (5) years. The mean (SD) left ventricular ejection fraction (LVEF) was 35% (17%). There were 2 (13%) postprocedural complications: 1 hematoma and 1 death. Mean (SD) follow-up was 24 (23) months. Survival rate was 63% (10/16) at 1 year and 56% (9/16) at 2 years, with 6/7 of those who died having LVEF < 35% at the time of the ICD implantation. Patients were more likely to receive appropriate therapy if their ICD was implanted for secondary (5/8) rather than primary (0/8) prevention (p = .007). Of those who did, 4 patients survived to 30 days post-ICD therapy. Severe CAV was not associated with the rate of appropriate therapy.
Conclusions:
Beneficial outcomes were observed when ICDs were implanted for secondary prevention only, and in patients with higher baseline LVEF. We also observed benefits with resynchronization therapy.
