Safety and efficacy of automatic implantable defibrillator used as a bridge to heart transplant

Abstract

DESPITE CONTINUOUS improvements in the clinical management of patients (pts) affected by chronic heart failure (CHF), heart transplant (Htx) still remains the treatment of choice in end-stage cardiac diseases. However, the discrepancy between numbers of pts and donor shortage and increasing waiting time is leading to a sensible worsening in terms of candidate survival rate. McManus et al. have reported threefold increase (from 0.07 in 1983 to 0.21 in 1989) in the ratio between the number of pts dying while awaiting transplantation and those successfully transplanted. Among the several different causes of death, malignant cardiac arrhythmias are responsible for sudden death of Htx candidates, ranging from 25% to 40%. Although different authors have suggested the implant of automatic cardioverter defibrillator (AICD) as a bridging device to Htx by reducing sudden death occurrence, debate is still running over the impact of the AICDs on prognosis of pts affected by severe left ventricular (LV) dysfunction. To assess safety and efficacy of AICD as bridge to Htx, our 6 years experience was reviewed.