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Prophylactic implantable cardioverter defibrillator treatment in patients with end-stage heart failure awaiting heart transplantation


Fröhlich, Georg M; Holzmeister, Johannes; Hübler, Michael; Hübler, Samira; Wolfrum, Mathias; Enseleit, Frank; Seifert, Burkhardt; Hürlimann, David; Lehmkuhl, Hans B; Noll, Georg; Steffel, Jan; Falk, Volkmar; Lüscher, Thomas F; Hetzer, Roland; Ruschitzka, Frank (2013). Prophylactic implantable cardioverter defibrillator treatment in patients with end-stage heart failure awaiting heart transplantation. Heart, 99(16):1158-1165.

Abstract

OBJECTIVES: This study was designed to delineate the role of implantable cardioverter defibrillator (ICD) therapy for the primary and secondary prevention of sudden cardiac death in patients listed for heart transplantation.
SETTING: Retrospective observational multicentre study.
PATIENTS: 1089 consecutive patients listed for heart transplantation in two tertiary heart transplant centres were enrolled. Of 550 patients (51%) on the transplant list with an ICD, 216 had received their ICD for the primary prevention of sudden cardiac death and 334 for secondary prevention. 539 patients did not receive an ICD.
INTERVENTION: Treatment with or without an ICD was left to the discretion of the heart failure specialist.
MAIN OUTCOME MEASURE: All-cause mortality.
RESULTS: ICDs appear to be associated with a reduction in all-cause mortality in patients implanted with the device for primary and secondary prevention compared to those without an ICD despite a median time on the waiting list of only 8 months (estimated 1-year: 88±3% vs 77±3% vs 67±3%; p=0.0001). A Cox regressional hazard model (corrected for age, sex, underlying heart disease, atrial fibrillation, cardiac resynchronisation therapy, New York Heart Association (NYHA) class, ejection fraction, co-medication and year of listing) suggested an independent beneficial effect of ICDs that was most pronounced in patients who had received an ICD for primary prevention (HR 0.4, 95% CI 0.19 to 0.85; p=0.016).
CONCLUSIONS: ICD implantation appears to be associated with an immediate and sustained survival benefit for patients awaiting heart transplantation.

Abstract

OBJECTIVES: This study was designed to delineate the role of implantable cardioverter defibrillator (ICD) therapy for the primary and secondary prevention of sudden cardiac death in patients listed for heart transplantation.
SETTING: Retrospective observational multicentre study.
PATIENTS: 1089 consecutive patients listed for heart transplantation in two tertiary heart transplant centres were enrolled. Of 550 patients (51%) on the transplant list with an ICD, 216 had received their ICD for the primary prevention of sudden cardiac death and 334 for secondary prevention. 539 patients did not receive an ICD.
INTERVENTION: Treatment with or without an ICD was left to the discretion of the heart failure specialist.
MAIN OUTCOME MEASURE: All-cause mortality.
RESULTS: ICDs appear to be associated with a reduction in all-cause mortality in patients implanted with the device for primary and secondary prevention compared to those without an ICD despite a median time on the waiting list of only 8 months (estimated 1-year: 88±3% vs 77±3% vs 67±3%; p=0.0001). A Cox regressional hazard model (corrected for age, sex, underlying heart disease, atrial fibrillation, cardiac resynchronisation therapy, New York Heart Association (NYHA) class, ejection fraction, co-medication and year of listing) suggested an independent beneficial effect of ICDs that was most pronounced in patients who had received an ICD for primary prevention (HR 0.4, 95% CI 0.19 to 0.85; p=0.016).
CONCLUSIONS: ICD implantation appears to be associated with an immediate and sustained survival benefit for patients awaiting heart transplantation.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2013
Deposited On:11 Jul 2013 07:13
Last Modified:05 Apr 2016 16:51
Publisher:BMJ Publishing Group
ISSN:1355-6037
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1136/heartjnl-2013-304185
PubMed ID:23813845

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