Kairav Vakil1, Felipe Kazmirczak2, Neeraj Sathnur2, Selcuk Adabag3, Daniel J Cantillon4, Erich L Kiehl4, Ryan Koene2, Rebecca Cogswell2, Inderjit Anand5, Henri Roukoz2. 1. Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, Minnesota; Division of Cardiology, University of Minnesota, Minneapolis, Minnesota. Electronic address: vakil012@umn.edu. 2. Division of Cardiology, University of Minnesota, Minneapolis, Minnesota. 3. Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, Minnesota; Division of Cardiology, University of Minnesota, Minneapolis, Minnesota. 4. Division of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio. 5. Division of Cardiology, Veterans Affairs Medical Center, San Diego, California.
Abstract
OBJECTIVES: This study evaluated the impact of implantable cardioverter-defibrillators (ICDs) on mortality in patients with left ventricular assist devices (LVADs) by conducting a systematic review and meta-analysis of published studies. BACKGROUND: The burden of ventricular arrhythmias in patients with LVADs is high. Prior studies assessing the impact of ICD on survival of patients with LVADs have yielded conflicting results. METHODS: Relevant studies from January 2000 through October 2015 were identified in the databases PubMed and OVID. Weighted relative risks were estimated using random effects meta-analysis techniques. RESULTS: Six observational studies (n = 937) were included. Patients were 53 ± 12 years of age, and 80% were male. Bridge-to-transplantation was the indication for LVAD use in 93% of the patients. A continuous-flow (CF) LVAD was present in 39% of patients. Mean left ventricular ejection fraction was 16 ± 6%. An ICD was present in 355 patients (38%). During a mean follow-up of 7 months, 241 patients (26%) died (16% in the ICD group vs. 32% in the no-ICD group). Presence of an ICD was associated with a 39% relative risk reduction in all-cause mortality (RR: 0.61; 95% confidence interval [CI]: 0.46 to 0.82; p < 0.01). Among subgroup of patients with CF-LVAD (n = 361), ICD use was associated with a statistically nonsignificant trend toward improved survival (RR: 0.76; 95% CI: 0.51 to 1.12; p = 0.17). CONCLUSIONS: ICD use was associated with a significant reduction in mortality in LVAD patients, however, this effect was not significant in patients with CF-LVADs. Although these data support the use of ICDs, larger randomized trial data are strongly warranted to evaluate ICD effectiveness in patients with current generation LVADs.
OBJECTIVES: This study evaluated the impact of implantable cardioverter-defibrillators (ICDs) on mortality in patients with left ventricular assist devices (LVADs) by conducting a systematic review and meta-analysis of published studies. BACKGROUND: The burden of ventricular arrhythmias in patients with LVADs is high. Prior studies assessing the impact of ICD on survival of patients with LVADs have yielded conflicting results. METHODS: Relevant studies from January 2000 through October 2015 were identified in the databases PubMed and OVID. Weighted relative risks were estimated using random effects meta-analysis techniques. RESULTS: Six observational studies (n = 937) were included. Patients were 53 ± 12 years of age, and 80% were male. Bridge-to-transplantation was the indication for LVAD use in 93% of the patients. A continuous-flow (CF) LVAD was present in 39% of patients. Mean left ventricular ejection fraction was 16 ± 6%. An ICD was present in 355 patients (38%). During a mean follow-up of 7 months, 241 patients (26%) died (16% in the ICD group vs. 32% in the no-ICD group). Presence of an ICD was associated with a 39% relative risk reduction in all-cause mortality (RR: 0.61; 95% confidence interval [CI]: 0.46 to 0.82; p < 0.01). Among subgroup of patients with CF-LVAD (n = 361), ICD use was associated with a statistically nonsignificant trend toward improved survival (RR: 0.76; 95% CI: 0.51 to 1.12; p = 0.17). CONCLUSIONS:ICD use was associated with a significant reduction in mortality in LVADpatients, however, this effect was not significant in patients with CF-LVADs. Although these data support the use of ICDs, larger randomized trial data are strongly warranted to evaluate ICD effectiveness in patients with current generation LVADs.
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