Abstract 18703: Impact of Implantable Cardioverter-defibrillators on Outcome of Patients With Left Ventricular Assist Devices

Abstract

Background: Ventricular arrhythmias are common in patients supported by left ventricular assist devices (LVAD). However, the benefit of de-novo implantable cardiac defibrillators (ICD) in patients with LVAD is not well established. Methods/Results: The Nationwide Inpatient Sample database identified 12010 LVAD implantations from 2008 to 2012. Among these, 24.8% (n=2975) had a prior ICD while 6.8% (n=614) received an ICD at the time of LVAD implantation. An increase in the rate of ICD implantation during the study period was noted [4.1% in 2008 vs. 6.6% in 2012, p trend = 0.019; adjusted odds ratio (OR) per year= 0.839; 95% confidence interval (CI)= 0.724-0.972]. De-novo ICD implantation was independently associated with reduction in in-hospital mortality in new LVAD recipients [OR=0.141 (95% CI=0.080-0.248); p<0.001]. Patients receiving ICD implants were younger (50.1 vs. 55.8 years, p<0.001). Female sex was an independent negative predictor of ICD implantation [0.601 (0.429- 0.843); p=0.003] and ICD recipients were more likely to be white. Acute myocardial infarction, ventricular tachycardia, ventricular fibrillation (VF), cardiac arrest and atrial fibrillation were independent predictors (p=0.001 for VF; P<0.001 for remainder) of de novo ICD implantation while the etiology of left ventricular dysfunction (ischemic vs. non-ischemic cardiomyopathy) did not predict ICD implantation [OR=0.824 (95% CI=0.593 -1.146); p=0.25]. Conclusion: De novo ICDs were implanted in a small proportion of LVAD recipients. However, it was associated with a significant reduction in in-hospital mortality.