Impact of Implantable Cardioverter Defibrillators on Survival of Patients with Centrifugal Left Ventricular Assist Devices

Abstract

Background: Both Implantable Cardioverter Defibrillators (ICD) and Left Ventricular Assist Devices (LVAD) have a positive impact on survival in the heart failure population. We sought to determine whether these effects on survival are additive or whether LVAD therapy supersedes ICD therapy. Method: We analysed survival data of patients implanted with non-pulsatile, centrifugal LVADs between October 2004 and March 2013. Outcomes in patients with ICDs (n = 61) were compared to those without ICDs (n = 39). Patients exited the study at the time of heart transplantation or death. Results: 100 patients underwent LVAD implantation during the specified dates (92 Bridge-to-transplant, eight Destination-therapy). Mean follow up time was 364 ± 295 days. Death occurred in 15 (38%) patients in the No ICD group vs. 18 (30%) in the ICD group (p = 0.55). At day 500 post LVAD implant, there was no significant difference in Kaplan–Meier survival curves between the two groups (p = 0.21). The two most common causes of death were sepsis, which occurred in nine (27%) patients, and intracranial haemorrhage in seven (21%). There were no patients that died of sudden cardiac death. One patient died whilst in sustained (1 h) ventricular fibrillation in the context of progressive multi-organ failure and sepsis. There was no significant difference in the time to heart transplantation (443 ± 251 days no ICD vs. 372 ± 277 days ICD, p = 0.37). Conclusion: Whilst ICD therapy has an established role in heart failure, there is no long term benefit from ICD therapy in the setting of non-pulsatile LVAD therapy for end-stage heart failure.