Implantable Cardioverter-Defibrillator Use in Patients With Left Ventricular Assist Devices

Abstract

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.

Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

“…Incidence of VA (defined as sustained ventricular tachyarrhythmias lasting >30 s or requiring ICD therapy) and ICD shocks following CF‐LVAD implantation in our study was comparable to the previous studies evaluating this 6, 21, 22, 27, 29. However, in contrast to the prior study from Schleifer et al,14 we did not observe any significant reduction in the incidence of VA or ICD shocks in the CRT group.…”

“…Data regarding the impact of ICD therapy on survival in LVAD recipients, however, have been conflicting. Two recent meta‐analyses of available observational studies show no significant survival benefit for ICD therapy in CF‐LVAD recipients 27, 28. Our data also did not show any significant independent association between the type of cardiac implantable electronic device (ICD versus CRT) and survival.…”

Implantable Cardioverter-defibrillator Therapy in the Patient with a Left Ventricular Assist Device: Still a Black Box

“…This analysis found a relative risk of 0.61 for all-cause mortality with a confidence interval of 0.46 to 0.82 (p o 0.01). 15 The major concern with these data is their generalizability to modern LVAD therapy, where the vast majority of patients are implanted with CF devices and have pre-existing ICDs in situ. As such, there is concern that the survival trend observed in this meta-analysis is likely to be confounded by a higher overall intensity of care, or by a selection bias toward patients with a better prognosis in individuals with an ICD implanted.…”

Is there a need for an implantable cardioverter defibrillator in patients with left ventricular assist devices? Time for MADIT-VAD!

“…Two recent meta-analyses combining data from these prior small studies on ICD efficacy concluded that there is no survival benefit with ICD in LVAD patients and urged the need for a randomized clinical trial [9,10].…”

“…In LVAD recipients, however, there remains an increased risk for ventricular tachyarrhythmias (VTAs) that has been shown to adversely impact outcomes [6,7]. Recommendations from the International Society of Hert and Lung Transplantation therefore suggest reactivation of an ICD following an LVAD placement (Class I, Level of Evidence A), and implantation of an ICD in those with no ICD before LVAD (Class IIa, Level of Evidence B) [8], based on small retrospective studies, expert consensus, or meta-analyses [9,10]. Despite such recommendations, whether an ICD is associated with survival benefit in LVAD patients remains controversial.…”