The efficacy of implantable cardioverter-defibrillators in heart transplant recipients: results from a multicenter registry.

Abstract

BACKGROUND:

Sudden cardiac death among orthotopic heart transplant recipients is an important mechanism of death after cardiac transplantation. The role for implantable cardioverter-defibrillators (ICDs) in this population is not well established. This study sought to determine whether ICDs are effective in preventing sudden cardiac death in high-risk heart transplant recipients.

METHODS AND RESULTS:

We retrospectively analyzed the records of all orthotopic heart transplant patients who had ICD implantation between January 1995 and December 2005 at 5 heart transplant centers. Thirty-six patients were considered high risk for sudden cardiac death. The mean age at orthotopic heart transplant was 44+/-14 years, the majority being male (n=29). The mean age at ICD implantation was 52+/-14 years, whereas the average time from orthotopic heart transplant to ICD implant was 8 years +/-6 years. The main indications for ICD implantation were severe allograft vasculopathy (n=12), unexplained syncope (n=9), history of cardiac arrest (n=8), and severe left ventricular dysfunction (n=7). Twenty-two shocks were delivered to 10 patients (28%), of whom 8 (80%) received 12 appropriate shocks for either rapid ventricular tachycardia or ventricular fibrillation. The shocks were effective in terminating the ventricular arrhythmias in all cases. Three (8%) patients received 10 inappropriate shocks. Underlying allograft vasculopathy was present in 100% (8 of 8) of patients who received appropriate ICD therapy.

CONCLUSIONS:

Use of ICDs after heart transplantation may be appropriate in selected high-risk patients. Further studies are needed to establish an appropriate prevention strategy in this population.

• Authors: Vivian W Tsai, Joshua Cooper, Hasan Garan, Andrea Natale, Leon M Ptaszek, Patrick T Ellinor, Kathleen Hickey, Ross Downey, Paul Zei, Henry Hsia, Paul Wang, Sharon Hunt, François Haddad, Amin Al-Ahmad
• Journal: Circulation. Heart failure (Circ Heart Fail) Vol. 2 Issue 3 Pg. 197-201 (May 2009) ISSN: 1941-3297 [Electronic] United States
• PMID: 19808340 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Atherosclerosis (etiology, therapy)
• Death, Sudden, Cardiac (etiology, prevention & control)
• Defibrillators, Implantable
• Electric Countershock (adverse effects, instrumentation)
• Female
• Heart Arrest (etiology, therapy)
• Heart Diseases (etiology, therapy)
• Heart Transplantation (adverse effects)
• Humans
• Logistic Models
• Male
• Middle Aged
• Registries
• Retrospective Studies
• Risk Assessment
• Syncope (etiology, therapy)
• Tachycardia, Ventricular (etiology, therapy)
• Time Factors
• Transplantation, Homologous
• Treatment Outcome
• United States
• Ventricular Dysfunction, Left (etiology, therapy)
• Ventricular Fibrillation (etiology, therapy)