Cardiac implantable electronic devices with a defibrillator component and all‐cause mortality in left ventricular assist device carriers: results from the PCHF‐VAD registry

Abstract

Aims To compare characteristics of left ventricular assist device (LVAD) recipients receiving a cardiac implantable electronic device (CIED) with a defibrillator component (implantable cardioverter‐defibrillator and cardiac resynchronization therapy with defibrillation, CIED‐D) vs. those without one, and to assess whether carrying such a device contiguously with an LVAD is associated with outcomes. Methods and results Overall, 448 patients were analysed (mean age 52 ± 13 years, 82% male) in the multicentre European PCHF‐VAD registry. To account for all active CIED‐Ds during ongoing LVAD treatment, outcome analyses were performed by a time‐varying analysis with active CIED‐D status post‐LVAD as the time‐varying covariate. At the time of LVAD implantation, 235 patients (52%) had an active CIED‐D. Median time on LVAD support was 1.1 years (interquartile range 0.5–2.0 years). A reduction of 36% in the risk of all‐cause mortality was observed in patients with an active CIED‐D [hazard ratio (HR) 0.64, 95% confidence interval (CI) 0.46–0.91; P = 0.012), increasing to 41% after adjustment for baseline covariates (HR 0.59, 95% CI 0.40–0.87; P = 0.008) and 39% after propensity score adjustment (HR 0.61, 95% CI 0.39–0.94; P = 0.027). Other than CIED‐D, age, LVAD implant as redo surgery, number of ventricular arrhythmia episodes and use of vasopressors pre‐LVAD were remaining significant risk factors of all‐cause mortality. Incident ventricular arrhythmias post‐LVAD portended a 2.4‐fold and 2.6‐fold increased risk of all‐cause and cardiovascular death, respectively; carrying an active CIED‐D remained associated with a 47% and 43% reduction in these events, respectively. Conclusions In an analysis accounting for all active CIED‐Ds, including those implanted during LVAD support, carrying such a device was associated with significantly better survival during LVAD support.

Heart failure in the last year: progress and perspective

“…228 Data from the Postgraduate Course in Heart Failure (PCHF)-VAD registry showed a better survival in LVAD patients who also received a cardiac implantable electronic device with a defibrillator component (HR 0.64; 95% CI 0.46-0.91; P = 0.012) compared with those who only had LVAD support. 229 Also, exercise training may provide incremental benefits in LVAD carriers. The rationale behind the Exercise training in patients with a LVAD (Ex-VAD) trial is to assess if a 12 week supervised exercise training could improve the quality of life and the functional capacity in LVAD patients.…”

September 2019 at a glance: focus on devices

“…It is not clear whether a cardiac implantable electronic device (CIED) is still useful in LVAD carriers. Cikes et al . compared the clinical characteristics and outcomes of 448 LVAD carriers with or without a CIED with an active defibrillator component.…”

“…The adjusted relative risk of all‐cause death was reduced by ≈40% in patients with an active CIED compared to those who did not. Elderly age, LVAD implantation as a redo procedure, number of clinically significant ventricular arrhythmia episodes pre‐LVAD, and use of vasopressors were also significant predictors of all‐cause mortality …”

Implantable cardioverter‐defibrillator therapy in patients with left ventricular assist devices: a shocking tale of survival

“…In the September issue of the Journal, Cikes et al . provide much needed insights into the use and outcomes of ICDs in LVAD patients treated in European centres.…”

“…In the September issue of the Journal, Cikes et al 8 provide much needed insights into the use and outcomes of ICDs in LVAD patients treated in European centres. Their findings add to a growing collection of retrospective studies that address the important and controversial topic of whether ICDs reduce mortality in patients with durable continuous-flow LVADs.…”