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Prophylactic implantable cardioverter defibrillator treatment in patients with end-stage heart failure awaiting heart transplantation
  1. Georg M Fröhlich1,
  2. Johannes Holzmeister1,
  3. Michael Hübler2,
  4. Samira Hübler2,
  5. Mathias Wolfrum1,
  6. Frank Enseleit1,
  7. Burkhardt Seifert3,
  8. David Hürlimann1,
  9. Hans B Lehmkuhl2,
  10. Georg Noll1,
  11. Jan Steffel1,
  12. Volkmar Falk4,
  13. Thomas F Lüscher1,
  14. Roland Hetzer2,
  15. Frank Ruschitzka1
  1. 1Cardiovascular Division, Cardiology, Heart Failure/Heart Transplant Unit, University Hospital Zurich, Zurich, Switzerland
  2. 2Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
  3. 3Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
  4. 4Department of Cardiothoracic and Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence to Prof. Dr. Frank Ruschitzka, University Hospital Zurich, Raemistrasse 100, Zürich CH-8091, Switzerland; frank.ruschitzka{at}usz.ch

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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