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Implantable Cardioverter Defibrillators in Patients With Continuous Flow Left Ventricular Assist Devices: Utilization Patterns, Related Procedures, and Complications
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| Zeitschriftentitel: | Journal of the American Heart Association |
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| Personen und Körperschaften: | , , , , , , , |
| In: | Journal of the American Heart Association, 8, 2019, 14 |
| Format: | E-Article |
| Sprache: | Englisch |
| veröffentlicht: |
Ovid Technologies (Wolters Kluwer Health)
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| Schlagwörter: |
| Zusammenfassung: | <jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> The effect of implantable cardioverter defibrillators ( <jats:styled-content style="fixed-case">ICD</jats:styled-content> ) in patients with continuous flow left ventricular assist devices ( <jats:styled-content style="fixed-case">LVAD</jats:styled-content> s) on outcomes has not been evaluated in a randomized clinical trial. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> This is a retrospective single‐center study that included patients who underwent continuous flow <jats:styled-content style="fixed-case">LVAD</jats:styled-content> implantation at the Cleveland Clinic between October 2004 and March 2017. Patients were evaluated according to the presence or absence of <jats:styled-content style="fixed-case">ICD</jats:styled-content> at the time of <jats:styled-content style="fixed-case">LVAD</jats:styled-content> insertion. Among 486 patients in the study cohort, 387 (79.6%) had an <jats:styled-content style="fixed-case">ICD</jats:styled-content> before <jats:styled-content style="fixed-case">LVAD</jats:styled-content> insertion. Patients with <jats:styled-content style="fixed-case">ICD</jats:styled-content> before <jats:styled-content style="fixed-case">LVAD</jats:styled-content> were older and had lower use of pre‐ <jats:styled-content style="fixed-case">LVAD</jats:styled-content> inotropes, extracorporeal membrane oxygenation, and mechanical ventilation. There were 81 patients (21.4% of patients with <jats:styled-content style="fixed-case">ICD</jats:styled-content> ) who required 93 procedures after <jats:styled-content style="fixed-case">LVAD</jats:styled-content> : 74 generator exchanges, 12 lead revisions, and 7 complete system removals because of infection. Of the 99 patients without <jats:styled-content style="fixed-case">ICD</jats:styled-content> , 52 (53%) underwent <jats:styled-content style="fixed-case">ICD</jats:styled-content> 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‐ <jats:styled-content style="fixed-case">LVAD ICD</jats:styled-content> was not associated with mortality in a multivariable model (hazard ratio 1.19, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.73–1.93, <jats:italic>P</jats:italic> =0.492), nor was the presence of an <jats:styled-content style="fixed-case">ICD</jats:styled-content> at any point when analyzed as a time‐varying covariate (hazard ratio 1.05, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.50–2.20, <jats:italic>P</jats:italic> =0.907). </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> There is no apparent mortality benefit associated with an <jats:styled-content style="fixed-case">ICD</jats:styled-content> in a contemporary cohort of patients with continuous flow <jats:styled-content style="fixed-case">LVAD</jats:styled-content> s to balance considerable morbidity involving <jats:styled-content style="fixed-case">ICD</jats:styled-content> ‐related procedures and complications. </jats:p> </jats:sec> |
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| ISSN: |
2047-9980
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| DOI: | 10.1161/jaha.118.011813 |