Title

The role of implantable cardioverter-defibrillators in patients with continuous flow left ventricular assist devices — A meta-analysis

Document Type

Article

Publication Title

International Journal of Cardiology

Abstract

Background Left ventricular assist devices (LVADs) and implantable cardioverter defibrillators (ICD) are each known to improve mortality in patients with advanced congestive heart failure (CHF). If ICDs contribute to improved survival specifically in recipients of LVADs is currently unknown. Aim To evaluate the impact of presence of ICD on mortality in continuous flow LVAD recipients. Methods A meta- analysis of available literature was performed. PubMed, Embase and Google Scholar databases were searched for studies that compared mortality in continuous flow LVAD patients with ICDs (new implantation or no de-activation) and without ICDs (including de-activation of existing implant). Pooled analysis using a fixed effects model was used for outcomes of interest. Results We included 3 observational studies for a total of 292 patients (203 (69.5%) with ICD versus 89 (30.5%) without ICD). The presence of an active ICD was not associated with improved survival [OR 0.63, 95% CI 0.33–1.18; p = 0.15]. In bridge to transplantation [BT] patients (224 patients, 149 with ICD versus 75 without ICD), an active ICD was not associated with a higher probability of survivzal [OR 1.47, 95% CI 0.78–2.76; p = 0.23]. There was no difference in the occurrence of severe right ventricular dysfunction or failure between two groups [OR 0.78, 95% CI 0.42–1.47; p = 0.45]. The risk of LVAD related complications were similar [OR 0.68, 95% CI 0.35–1.31; P = 0.25]. Conclusion This meta-analysis demonstrates that there is no survival benefit with ICD in heart failure patients supported with continuous flow LVAD. There is an urgent need of large-scale randomized trials to specifically address this issue.

First Page

379

Last Page

384

DOI

10.1016/j.ijcard.2016.07.257

Publication Date

11-1-2016

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