Impact of ICD Presence in Patients With Left Ventricular Assist Devices for End-Stage Heart Failure.

Background

The prognostic relevance of implantable cardioverter defibrillator (ICD) in patients with end-stage heart failure (HF) with left ventricular assist device (LVAD) remains controversial.

Objectives

To evaluate the prognostic impact of ongoing use of ICD and associated complications in HF-patients with LVAD-implantation.

Methods

We retrospectively analyzed all consecutive patients (n = 351) who underwent LVAD-implantation and follow up between 2009 and 2021. Patients were categorized according to the presence (n = 254) or absence (n = 97) of ICD. To reduce baseline imbalances between groups, propensity score matching (PSM) was performed, yielding two matched cohorts of 79 patients each. The primary endpoint was a composite of all-cause mortality and heart transplantation. Secondary endpoints included all-cause mortality, heart transplantation, and ICD-related complications.

Results

Median age was 58 [49-65] years, and 85% were male. Median follow-up duration was 3.6 [2.6-5.7] years. The primary endpoint revealed significantly less events in the ICD cohort (44.3% vs. 59.5% (HR 0.6 95%CI [0.40; 0.97], p = 0.035)). The difference was driven by a higher rate of all-cause mortality (22.08% vs. 41.8%, p = 0.008), while the heart transplantation rate was similar (17.7% vs. 21.5%, p = 0.98). ICD-related complications occurred in 20.4% of all ICD-patients, including 27 lead revisions, 8 complete system removals due to infection, 13 inadequate shocks and 4 hematoma evacuations.

Conclusion

ICD therapy was associated with lower mortality in this single-center LVAD-cohort. However, this finding contrasts with recent meta-analytic. Given the substantial burden of ICD-related complications, ICD-management after LVAD-implantation should be individualized according to arrhythmic risk, pacing requirements, procedural risk, and patient preferences.