Prognostic Impact of Implantable Cardioverter Defibrillators in Patients with Continuous Flow Left Ventricular Assist Devices

Background: Preventative implantation of implantable cardioverter defibrillators (ICD) improves survival of symptomatic heart failure (HF) patients with reduced left ventricular ejection fraction. Nevertheless, the prognostic impact of ICD therapy in continuous flow left ventricular assist device (LVAD) recipients remains controversial.

Method: A total of 162 consecutive HF patients underwent LVAD implantation at our institution between 2010 and 2019. All patients were evaluated according to the presence (n = 94, ICD group) or absence (n = 68, control group) of ICDs prior to LVAD implantation. Apart from clinical baseline and follow-up parameters, adverse events related to ICD therapy (e.g., lead-dysfunction, unplanned ICD re-intervention, inadequate or awake ICD shocks) and overall survival rates were retrospectively analyzed.

Results: Predominantly male patients (87.0%) with a median age of 57 (48.8–64.0) years were mainly treated with the Medtronic HVAD device (87.0%). Ischemic cardiomyopathy (60.3 vs. 38.3%, p = 0.007) and severe HF symptoms (e.g., NYHA-class IV 85.5% versus 59.6%, p = 0.001) were more prevalent within the Control-group. Furthermore, the preoperative use of short-term circulatory support devices (e.g., IABP, ECMO, Impella) was higher within the Control-group (54.4 vs. 13.8%, p < 0.001). Nevertheless, baseline severity of LV and RV dysfunction (LVEF 20%, TAPSE 15 mm; p = 0.87) was comparable between both study-groups. Apart from an increased rate of temporary RVAD implantation within the Control-group (45.6 vs. 17.0%; p < 0.001), procedural characteristics and 30-day mortality rates (12.8% ICD group vs. 20.6% control group; p = 0.20) were comparable. Furthermore, overall survival during a median follow-up of 14 (3.0–36.5) months was similar within both study groups (35.1% ICD group vs. 33.8% control group; p = 0.46). During the first 2 years after LVAD implantation, 49 ICD-related adverse events occurred within the ICD group. Thereof, lead dysfunction occurred in 18 patients and unplanned ICD reintervention in 10 patients. Furthermore, in 16 patients adequate, but awake shocks occurred, whereas inadequate shocks occurred in 5 patients.

Conclusion: ICD therapy in LVAD recipients was not associated with a survival benefit or reduced morbidity after LVAD implantation. Furthermore, in the majority of LVAD recipients ICD-related adverse events occurred during follow-up. A randomized controlled trial is essential to elucidate the role of ICD therapy in LVAD recipients.

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Artikel online veröffentlicht:
03. Februar 2022