Implantable Cardioverter-Defibrillators and Cardiovascular Resynchronization Therapy with Left Ventricular Assist...

Area of Science:

• Cardiology
• Medical Devices
• Heart Failure Management

Background:

• The efficacy of implantable cardioverter-defibrillators (ICDs) and cardiovascular resynchronization therapy defibrillators (CRT-Ds) in patients with a HeartMate 3 left ventricular assist device (LVAD) is not well-established.
• The MOMENTUM 3 trial provided data on patients with LVADs, but the specific impact of concomitant defibrillator therapy requires further investigation.

Purpose of the Study:

• To evaluate the association of ICDs and CRT-Ds with clinical outcomes in patients receiving a HeartMate 3 LVAD.
• To compare the outcomes between patients with no defibrillator, ICD only, and CRT-D in the context of LVAD support.

Main Methods:

• A post-hoc analysis of the MOMENTUM 3 randomized clinical trial and its Continued Access Protocol (CAP) was performed.
• Patients were stratified into three groups: no device, ICD only, and CRT-D.
• Outcomes including overall mortality, ventricular arrhythmias (VAs), rehospitalization, quality of life, and 6-minute walk test distance were assessed at 2-year follow-up.

Main Results:

• Patients with ICDs or CRT-Ds showed similar survival and rehospitalization rates compared to those without defibrillator support.
• The incidence of ventricular arrhythmias (VAs) was significantly higher in patients with ICDs or CRT-Ds.
• Compared to ICD alone, CRT-D was associated with similar survival but increased VA rates.

Conclusions:

• The implantation of an ICD or CRT-D alongside a HeartMate 3 LVAD did not confer survival benefits or improve quality of life or functional capacity.
• These devices were, however, associated with an increased incidence of ventricular arrhythmias in this patient population.
• The findings suggest a need for careful consideration regarding the routine use of ICDs/CRT-Ds in conjunction with HeartMate 3 LVADs.