Implantable Cardioverter Defibrillators in Patients With Continuous Flow Left Ventricular Assist Devices: Utilization Patterns, Related Procedures, and Complications
Background The effect of implantable cardioverter defibrillators (ICD) in patients with continuous flow left ventricular assist devices (LVADs) on outcomes has not been evaluated in a randomized clinical trial. Methods and Results This is a retrospective single‐center study that included patients wh...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.011813 |
| _version_ | 1818312242826838016 |
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| author | Paulino A. Alvarez Brett W. Sperry Antonio L. Pérez Dmitry M. Yaranov Varinder Randhawa Jacob Luthman Daniel J. Cantillon Randall C. Starling |
| author_facet | Paulino A. Alvarez Brett W. Sperry Antonio L. Pérez Dmitry M. Yaranov Varinder Randhawa Jacob Luthman Daniel J. Cantillon Randall C. Starling |
| author_sort | Paulino A. Alvarez |
| collection | DOAJ |
| description | Background The effect of implantable cardioverter defibrillators (ICD) in patients with continuous flow left ventricular assist devices (LVADs) on outcomes has not been evaluated in a randomized clinical trial. Methods and Results This is a retrospective single‐center study that included patients who underwent continuous flow LVAD implantation at the Cleveland Clinic between October 2004 and March 2017. Patients were evaluated according to the presence or absence of ICD at the time of LVAD insertion. Among 486 patients in the study cohort, 387 (79.6%) had an ICD before LVAD insertion. Patients with ICD before LVAD were older and had lower use of pre‐LVAD inotropes, extracorporeal membrane oxygenation, and mechanical ventilation. There were 81 patients (21.4% of patients with ICD) who required 93 procedures after LVAD: 74 generator exchanges, 12 lead revisions, and 7 complete system removals because of infection. Of the 99 patients without ICD, 52 (53%) underwent ICD implantation: 29 for primary prevention and 23 for secondary prevention. Patients were followed for a median of 401 (interquartile range 150–966) days. The presence of a pre‐LVAD ICD was not associated with mortality in a multivariable model (hazard ratio 1.19, 95% CI 0.73–1.93, P=0.492), nor was the presence of an ICD at any point when analyzed as a time‐varying covariate (hazard ratio 1.05, 95% CI 0.50–2.20, P=0.907). Conclusions There is no apparent mortality benefit associated with an ICD in a contemporary cohort of patients with continuous flow LVADs to balance considerable morbidity involving ICD‐related procedures and complications. |
| first_indexed | 2024-12-13T08:14:45Z |
| format | Article |
| id | doaj.art-15b8f099b18a4c84a2fd5139c4ae0556 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T08:14:45Z |
| publishDate | 2019-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-15b8f099b18a4c84a2fd5139c4ae05562022-12-21T23:54:09ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-07-0181410.1161/JAHA.118.011813Implantable Cardioverter Defibrillators in Patients With Continuous Flow Left Ventricular Assist Devices: Utilization Patterns, Related Procedures, and ComplicationsPaulino A. Alvarez0Brett W. Sperry1Antonio L. Pérez2Dmitry M. Yaranov3Varinder Randhawa4Jacob Luthman5Daniel J. Cantillon6Randall C. Starling7Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland OHBackground The effect of implantable cardioverter defibrillators (ICD) in patients with continuous flow left ventricular assist devices (LVADs) on outcomes has not been evaluated in a randomized clinical trial. Methods and Results This is a retrospective single‐center study that included patients who underwent continuous flow LVAD implantation at the Cleveland Clinic between October 2004 and March 2017. Patients were evaluated according to the presence or absence of ICD at the time of LVAD insertion. Among 486 patients in the study cohort, 387 (79.6%) had an ICD before LVAD insertion. Patients with ICD before LVAD were older and had lower use of pre‐LVAD inotropes, extracorporeal membrane oxygenation, and mechanical ventilation. There were 81 patients (21.4% of patients with ICD) who required 93 procedures after LVAD: 74 generator exchanges, 12 lead revisions, and 7 complete system removals because of infection. Of the 99 patients without ICD, 52 (53%) underwent ICD implantation: 29 for primary prevention and 23 for secondary prevention. Patients were followed for a median of 401 (interquartile range 150–966) days. The presence of a pre‐LVAD ICD was not associated with mortality in a multivariable model (hazard ratio 1.19, 95% CI 0.73–1.93, P=0.492), nor was the presence of an ICD at any point when analyzed as a time‐varying covariate (hazard ratio 1.05, 95% CI 0.50–2.20, P=0.907). Conclusions There is no apparent mortality benefit associated with an ICD in a contemporary cohort of patients with continuous flow LVADs to balance considerable morbidity involving ICD‐related procedures and complications.https://www.ahajournals.org/doi/10.1161/JAHA.118.011813implanted cardioverter defibrillatorinfectionleft ventricular assist device |
| spellingShingle | Paulino A. Alvarez Brett W. Sperry Antonio L. Pérez Dmitry M. Yaranov Varinder Randhawa Jacob Luthman Daniel J. Cantillon Randall C. Starling Implantable Cardioverter Defibrillators in Patients With Continuous Flow Left Ventricular Assist Devices: Utilization Patterns, Related Procedures, and Complications Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease implanted cardioverter defibrillator infection left ventricular assist device |
| title | Implantable Cardioverter Defibrillators in Patients With Continuous Flow Left Ventricular Assist Devices: Utilization Patterns, Related Procedures, and Complications |
| title_full | Implantable Cardioverter Defibrillators in Patients With Continuous Flow Left Ventricular Assist Devices: Utilization Patterns, Related Procedures, and Complications |
| title_fullStr | Implantable Cardioverter Defibrillators in Patients With Continuous Flow Left Ventricular Assist Devices: Utilization Patterns, Related Procedures, and Complications |
| title_full_unstemmed | Implantable Cardioverter Defibrillators in Patients With Continuous Flow Left Ventricular Assist Devices: Utilization Patterns, Related Procedures, and Complications |
| title_short | Implantable Cardioverter Defibrillators in Patients With Continuous Flow Left Ventricular Assist Devices: Utilization Patterns, Related Procedures, and Complications |
| title_sort | implantable cardioverter defibrillators in patients with continuous flow left ventricular assist devices utilization patterns related procedures and complications |
| topic | implanted cardioverter defibrillator infection left ventricular assist device |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.011813 |
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