Author + information
- Received April 12, 2016
- Revision received May 2, 2016
- Accepted May 5, 2016
- Published online October 1, 2016.
- Kairav Vakil, MDa,b,∗ (, )
- Felipe Kazmirczak, MDb,
- Neeraj Sathnur, MDb,
- Selcuk Adabag, MD, MSa,b,
- Daniel J. Cantillon, MDc,
- Erich L. Kiehl, MDc,
- Ryan Koene, MDb,
- Rebecca Cogswell, MDb,
- Inderjit Anand, MD, DPhil (Oxon)d and
- Henri Roukoz, MDb
- aDivision of Cardiology, Veterans Affairs Medical Center, Minneapolis, Minnesota
- bDivision of Cardiology, University of Minnesota, Minneapolis, Minnesota
- cDivision of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
- dDivision of Cardiology, Veterans Affairs Medical Center, San Diego, California
- ↵∗Reprint requests and correspondence:
Dr. Kairav Vakil, Division of Cardiology, Department of Medicine, Veterans Affairs Medical Center and University of Minnesota, 111C, One Veterans Drive, Minneapolis, Minnesota 55417.
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.
- implantable cardioverter-defibrillator
- left ventricular assist device
- systematic review
Dr. Cantillon is a consultant for and has received grants from St. Jude Medical and Boston Scientific. Dr. Vakil has received a grant from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Drs. Vakil and Kazmirczak contributed equally to this work.
- Received April 12, 2016.
- Revision received May 2, 2016.
- Accepted May 5, 2016.
- 2016 American College of Cardiology Foundation