The impact of implantable cardioverter-defibrillators on mortality among patients on the waiting list for heart transplantation

Abstract

Implantable cardioverter-defibrillators were investigated for their impact on mortality in 228 consecutive heart transplant candidates on the waiting list for transplantation (207 patients without and 21 with implantable cardioverter-defibrillator therapy). The mortality rate in 207 patients without implantable cardioverter-defibrillator therapy was 23.2% and in 21 patients with implantable cardioverter-defibrillator therapy was 4.7%. In a Cox proportional hazards model for all 228 study patients (mortality while on the waiting list: 21.5%; transplantation rate: 54.8%), the absence of an implantable cardioverter-defibrillator was only a marginally significant predictor of mortality (p = 0.079). However, the absence of an implantable cardioverter-defibrillator was a powerful predictor of mortality for a subgroup of 134 patients with high-grade ventricular arrhythmias on Holter electrocardiography (mortality while on the waiting list: 26.1%; transplantation rate: 54.5%; p = 0.022) and for a subgroup of 58 survivors of sudden cardiac death (mortality while on the waiting list: 22.4%; transplantation rate: 56.9%; p = 0.018). Implantable cardioverter-defibrillator therapy can be strongly recommended in transplant candidates with a history of sudden cardiac death. Recommendations for an expanded, prophylactic use of implantable cardioverter-defibrillator therapy in heart transplant candidates cannot be given.

Survival Benefit of the Implantable Cardioverter-Defibrillator in Patients on the Waiting List for Cardiac Transplantation

“…In a retrospective analysis, Sweeney et al 21 found that ICD therapy in patients on the waiting list for cardiac transplantation (nϭ32) improved neither overall nor sudden death-free survival compared with patients with or without antiarrhythmic drug treatment. Grimm et al 22 analyzed the influence of ICD therapy on mortality in 228 consecutive patients on the waiting list for cardiac transplantation. They demonstrated a survival benefit of ICD therapy for selected patient subgroups of survivors of sudden cardiac death and patients with high-grade ventricular arrhythmias on Holter ECG.…”

Association between implantable cardioverter-defibrillator and survival in patients awaiting heart transplantation: A meta-analysis and systematic review

“…statistically significant survival benefit. 24 This contradicts more recent studies demonstrating improved outcomes for ICDs implanted for both primary and secondary prevention. In a multicenter study with 1089 patients, the survival benefit was actually more pronounced in patients who received an ICD for primary prevention vs the non-ICD group (88% vs 67%, P , .0001) as compared to secondary prevention vs the non-ICD group (77% vs 67%, P 5 .01).…”

Treatment of arrhythmias in heart failure

“…As a result the ICD has been proposed to avoid sudden death in patients who could otherwise expect prolonged survival following transplantation. A recent study has shown benefit in implanting defibrillators in patients with life‐threatening ventricular tachyarrhythmias awaiting transplantation . However, the hypothesis that prophylactic ICD implantation in all patients as a ‘bridge’ to transplantation will result in significant survival benefit remains to be proven in a prospective trial.…”