Kuldeep Shah1, Rahul Chaudhary2, Mohit K Turagam3, Mahek Shah4, Brijesh Patel5, Gregg Lanier6, Dhanunjaya Lakkireddy7,8, Jalaj Garg9,8. 1. Division of Cardiology, Cardiac Arrhythmia Service, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan. 2. Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA. 3. Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY. 4. Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA. 5. Division of Cardiology, West Virginia University Medical Center, Morgantown, VW. 6. Division of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY. 7. Cardiac Arrhythmia Service, Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, KS. 8. DL and JG are co-senior authors. 9. Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, CA.
Abstract
INTRODUCTION: Implantable cardioverter-defibrillator (ICD) in patients with heart failure with reduced ejection fraction reduces mortality secondary to malignant arrhythmias. Whether end-stage heart failure (HF) with continuous-flow left ventricular assist device (cf-LVAD) derive similar benefits remains controversial. METHODS: We performed a systematic literature review and meta-analysis of all published studies that examined the association between active ICDs and survival in advanced HF patients with cfLVAD. We searched PubMed, Medline, Embase, Ovid, and Cochrane for studies reporting the association between ICD and all-cause mortality in advanced HF patients with cfLVAD. Mantel-Haenszel risk ratio (RR) random-effects model was used to summarize data. RESULTS: Ten studies (9 retrospective and one prospective) with a total of 7,091 patients met inclusion criteria. There was no difference in all-cause mortality (RR 0.84, 95% CI 0.65-1.10, p=0.20, I2 =62.40%), likelihood of survival to transplant (RR 1.07, 95% CI 0.98-1.17, p= 0.13, I2 =0%), RV failure (RR 0.74, 95% CI 0.44-1.25, p = 0.26, I2 =34%) between Active ICD and inactive/no ICD groups, respectively. Additionally, 27.5% received appropriate ICD shocks, while 9.5% received inappropriate ICD shocks. No significant difference was observed in terms of any complications between the two groups. CONCLUSIONS: All-cause mortality, the likelihood of survival to transplant, and worsening RV failure were not significantly different between active ICD and inactive/no ICD in cf-LVAD recipients. A substantial number of patients received appropriate ICD shocks suggesting a high-arrhythmia burden. The risks and benefits of ICDs must be carefully considered in patients with cf-LVAD.
INTRODUCTION: Implantable cardioverter-defibrillator (ICD) in patients with heart failure with reduced ejection fraction reduces mortality secondary to malignant arrhythmias. Whether end-stage heart failure (HF) with continuous-flow left ventricular assist device (cf-LVAD) derive similar benefits remains controversial. METHODS: We performed a systematic literature review and meta-analysis of all published studies that examined the association between active ICDs and survival in advanced HF patients with cfLVAD. We searched PubMed, Medline, Embase, Ovid, and Cochrane for studies reporting the association between ICD and all-cause mortality in advanced HF patients with cfLVAD. Mantel-Haenszel risk ratio (RR) random-effects model was used to summarize data. RESULTS: Ten studies (9 retrospective and one prospective) with a total of 7,091 patients met inclusion criteria. There was no difference in all-cause mortality (RR 0.84, 95% CI 0.65-1.10, p=0.20, I2 =62.40%), likelihood of survival to transplant (RR 1.07, 95% CI 0.98-1.17, p= 0.13, I2 =0%), RV failure (RR 0.74, 95% CI 0.44-1.25, p = 0.26, I2 =34%) between Active ICD and inactive/no ICD groups, respectively. Additionally, 27.5% received appropriate ICD shocks, while 9.5% received inappropriate ICD shocks. No significant difference was observed in terms of any complications between the two groups. CONCLUSIONS: All-cause mortality, the likelihood of survival to transplant, and worsening RV failure were not significantly different between active ICD and inactive/no ICD in cf-LVAD recipients. A substantial number of patients received appropriate ICD shocks suggesting a high-arrhythmia burden. The risks and benefits of ICDs must be carefully considered in patients with cf-LVAD.
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