340: Sudden cardiac death in heart transplant patients: Is there a role for defibrillators?

Montpetit, M.; Singh, Manavotam; Müller, E; Feldman, Charles L.; Sinacore, James; Pavlovic-Surjancev, Biljana; Heroux, A.

doi:10.1016/j.healun.2006.11.360

Cited by 7 publications

(7 citation statements)

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“…(2, 8, 9, 14) CAV is a well established risk factor for graft loss and death in pediatric series. (12, 18, 19) One pediatric case series found a very high incidence of sudden death or aborted sudden death in patients with CAV.…”

Section: Discussionmentioning

confidence: 99%

“…(1–5) Sudden death has been independently associated with cardiac allograft vasculopathy (CAV), acute cellular rejection, presence of Quilty lesion on endomyocardial biopsy (EMB), African-American ethnicity, and left ventricular dysfunction. (2, 4, 6–9) Several studies have suggested that primary prevention efforts, such as increased rejection screening and implantable cardiac defibrillator (ICD) placement, should be considered for these high-risk populations. (2, 5, 8, 10, 11)…”

Section: Introductionmentioning

confidence: 99%

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Sudden death after pediatric heart transplantation: Analysis of data from the Pediatric Heart Transplant Study Group

Daly¹,

Chakravarti²,

Tresler³

et al. 2011

The Journal of Heart and Lung Transplantation

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BACKGROUND Sudden death is a well-recognized complication of heart transplantation. Little is known about the incidence and risk factors for sudden death following transplant in children. The purpose of this study was to determine the incidence of and risk factors for sudden death. METHODS Retrospective multi-center cohort study using the Pediatric Heart Transplant Study Group (PHTS) database, an event driven registry of children <18 years of age at listing undergoing heart transplantation between 1993 and 2007. Standard Kaplan-Meier and parametric analyses were used for survival analysis. Multivariate analysis in the hazard-function domain was used to identify risk factors for sudden death after transplant. RESULTS Of 2491 children who underwent heart transplantation, 604 died of which 94 (16%) were classified as sudden. Freedom from sudden death was 97% at 5 years and the hazard for sudden death remained constant over time at 0.01 deaths per year. Multivariate risk factors associated with sudden death include black race (HR 2.6; p<0.0001), UNOS Status 2 at transplant (HR 1.8; p=0.008), older age (HR 1.4 per 10 years of age; p=0.03), and an increased number of rejection episodes in the first post-transplant year (HR 1.6 per episode; p=0.03). CONCLUSION Sudden death accounts for one in six deaths after heart transplant in children. Older recipient age, recurrent rejection within the first year, black race, and UNOS status 2 at listing were associated with sudden death. Patients with one or more of these risk factors may benefit from primary prevention efforts.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sudden death after pediatric heart transplantation: Analysis of data from the Pediatric Heart Transplant Study Group

Daly¹,

Chakravarti²,

Tresler³

et al. 2011

The Journal of Heart and Lung Transplantation

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“…Several small studies report widely varying numbers of patients (0.5% to 15%) experiencing SCD after cardiac transplantation. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] The cause of sudden death after heart transplantation is multifactorial with possible contributions from graft injury and ischemic triggers. 16 In the first year after transplantation, SCD usually occurs in the setting of acute rejection.…”

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confidence: 99%

The Efficacy of Implantable Cardioverter-Defibrillators in Heart Transplant Recipients

Tsai

Cooper

Garan

et al. 2009

Circ: Heart Failure

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Background-Sudden cardiac death among orthotopic heart transplant recipients is an important mechanism of death after cardiac transplantation. The role for implantable cardioverter-defibrillators (ICDs) in this population is not well established. This study sought to determine whether ICDs are effective in preventing Sudden cardiac death in high-risk heart transplant recipients. Methods and Results-We retrospectively analyzed the records of all orthotopic heart transplant patients who had ICD implantation between January 1995 and December 2005 at 5 heart transplant centers. Thirty-six patients were considered high risk for sudden cardiac death. The mean age at orthotopic heart transplant was 44Ϯ14 years, the majority being male (nϭ29). The mean age at ICD implantation was 52Ϯ14 years, whereas the average time from orthotopic heart transplant to ICD implant was 8 years Ϯ6 years. The main indications for ICD implantation were severe allograft vasculopathy (nϭ12), unexplained syncope (nϭ9), history of cardiac arrest (nϭ8), and severe left ventricular dysfunction (nϭ7). Twenty-two shocks were delivered to 10 patients (28%), of whom 8 (80%) received 12 appropriate shocks for either rapid ventricular tachycardia or ventricular fibrillation. The shocks were effective in terminating the ventricular arrhythmias in all cases. Three (8%) patients received 10 inappropriate shocks. Underlying allograft vasculopathy was present in 100% (8 of 8) of patients who received appropriate ICD therapy. Conclusions-Use of ICDs after heart transplantation may be appropriate in selected high-risk patients. Further studies are needed to establish an appropriate prevention strategy in this population. (Circ Heart Fail. 2009;2:197-201.)

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“…9 Among the 18 patients described in reports by Ptaszek et al, 8 Cogert et al, 9 and ourselves in this article (none of our other HTx patients has had an ICD), only 3 survived arrhythmias to which the ICD responded appropriately; all 3 had CAV, but 2 had LVEFs of 60%. The number with LVEF of less than 40%, the condition associated with SD in the study by Montpetit et al, 4 is not known; but of the 11 with LVEF of 45% or less (at least 10 of them with CAV), only 1 received appropriate shocks that may have been life-saving, and between 2 and 4 patients died without their ICD having been of any help.…”

Section: Discussionmentioning

confidence: 97%

“…[1][2][3][4] In the absence of ECG or autopsy evidence to the contrary, SD is generally attributed to ventricular arrhythmia: ventricular tachycardia or fibrillation due to acute ischemia or reentry in a myocardial scar, or bradyarrhythmia. Montpetit et al 4 found that SD was significantly associated with low LVEF (Ͻ40%), regardless of whether CAV was present, but was not significantly associated with CAV if LVEF was 40% or higher.…”

Section: Discussionmentioning

confidence: 99%

Sudden Cardiac Death of Two Heart Transplant Patients With Correctly Functioning Implantable Cardioverter Defibrillators

Marzoa-Rivas

Pérez-Álvarez

Paniagua‐Martin

et al. 2009

The Journal of Heart and Lung Transplantation

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340: Sudden cardiac death in heart transplant patients: Is there a role for defibrillators?

Cited by 7 publications

References 0 publications

Sudden death after pediatric heart transplantation: Analysis of data from the Pediatric Heart Transplant Study Group

Sudden death after pediatric heart transplantation: Analysis of data from the Pediatric Heart Transplant Study Group

The Efficacy of Implantable Cardioverter-Defibrillators in Heart Transplant Recipients

Sudden Cardiac Death of Two Heart Transplant Patients With Correctly Functioning Implantable Cardioverter Defibrillators

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