Presence of Implantable Cardioverter-Defibrillators and Wait-List Mortality of Patients Supported with Left Ventricular Assist Devices as Bridge to Heart Transplantation

Abstract

Background: The role of implantable cardioverter defibrillator (ICD) in reducing mortality in patients with left ventricular assisted devices (LVADs) listed for heart transplant remains unclear. We therefore, sought to interrogate whether ICDs are associated with reduced mortality in patients with LVADs listed for heart transplantation.

Methods: We searched the United Network for Organ Sharing (UNOS) Registry for LVAD patients (age≥18years) with dilated cardiomyopathies listed for heart transplantation (2008-2015). The group was matched by propensity scores with respect to presence of ICD at listing. The primary end-point was waitlist mortality, while secondary endpoints were waitlist mortality, delisting, or cardiovascular cause-specific mortality in patients with and without ICD.

Results: A total of 1444 LVAD patients were included in this analysis (722 with ICD, 722 without ICD). No statistically-significant differences were present between the two groups in demographics, device type, listing status, or hemodynamics. The presence of an ICD was not associated with decreased wait-list mortality (Hazard Ratio 1.19 [0.75-1.88], p=0.46), waitlist mortality/delisting (Hazard Ratio 1.20 [0.86-1.67], p=0.28), or cardiovascular wait-list mortality (HR 1.24 [0.45-3.43], p=0.67) over a median of 5.6months. Only 7 deaths occurred due to arrhythmia/cardiac arrest (2 in the ICD group and 5 in the non-ICD group).

Conclusion: Presence of ICDs at listing in heart failure patients bridged to transplantation with durable LVADs is not associated with lower waitlist mortality, cardiovascular wait-list mortality or wait-list mortality or delisting; however, there were numerically fewer arrhythmic deaths in the ICD group. Additional prospective studies should be undertaken to confirm these findings.

Keywords: ICD; LVAD; Wait-list mortality.