The role of implantable cardioverter-defibrillators in patients with continuous flow left ventricular assist devices - A meta-analysis.
Publication/Presentation Date
11-1-2016
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.
Volume
222
First Page
379
Last Page
384
ISSN
1874-1754
Published In/Presented At
Agrawal, S., Garg, L., Nanda, S., Sharma, A., Bhatia, N., Manda, Y., Singh, A., Fegley, M., & Shirani, J. (2016). The role of implantable cardioverter-defibrillators in patients with continuous flow left ventricular assist devices - A meta-analysis. International journal of cardiology, 222, 379–384. https://doi.org/10.1016/j.ijcard.2016.07.257
Disciplines
Medicine and Health Sciences
PubMedID
27505320
Department(s)
Fellows and Residents
Document Type
Article