Document Detail


Selected patients listed for cardiac transplantation may benefit from defibrillator implantation regardless of an established indication.
MedLine Citation:
PMID:  12681418     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: End-stage heart failure (HF) patients are at high risk of sudden cardiac death. This study evaluates the role of implantable cardiac defibrillators (ICDs) in HF patients awaiting cardiac transplantation. METHODS: We identified 194 consecutive patients (age 51 +/- 12 years) with New York Heart Association Class 3 or 4 HF (ejection fraction 22 +/- 9%) listed for cardiac transplantation, 35 of whom underwent ICD implantation. Of the implanted patients, 16 (Group A) had an established indication for ICD implantation (cardiac arrest, n = 10; sustained ventricular tachycardia [VT], n = 3; and positive electrophysiology study, n = 3). Nineteen patients (Group B) underwent ICD implantation for non-established indications (syncope with non-ischemic cardiomyopathy, n = 4; non-sustained VT, n = 15). There were no procedural complications from ICD implantation. RESULTS: During follow-up of 9.2 +/- 10.1 months, there were 3 deaths in the ICD groups (A and B), and 40 in the control group (8.6% vs 25.2%, p = 0.032). Five patients in Group A and 6 in Group B (31%) received appropriate ICD therapy. The number of therapies per patient and the time to the first shock were similar between Groups A and B. Four of 6 Group B patients on outpatient inotropic therapy (67%) received appropriate ICD therapy. CONCLUSIONS: Selected end-stage heart failure patients awaiting heart transplantation, including those without established ICD indications, are at high risk for malignant arrhythmias and may benefit from ICD implantation. Patients with ICD seem to have improved survival compared to those without ICD. Randomized prospective studies are needed to confirm these findings.
Authors:
Samir Saba; Walter L Atiga; William Barrington; Leonard I Ganz; Robert L Kormos; Guy A MacGowan; Michael A Mathier; Dennis M McNamara; Ogundu Obioha-Ngwu; Srinivas Murali
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation     Volume:  22     ISSN:  1053-2498     ISO Abbreviation:  J. Heart Lung Transplant.     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-08     Completed Date:  2003-09-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9102703     Medline TA:  J Heart Lung Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  411-8     Citation Subset:  IM    
Affiliation:
Electrophysiology Division of the Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. sabas@msx.upmc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Death, Sudden, Cardiac / etiology*,  prevention & control*
Defibrillators, Implantable*
Female
Follow-Up Studies
Heart Failure / complications*,  mortality,  therapy*
Heart Transplantation*
Humans
Male
Middle Aged
Outcome Assessment (Health Care)
Patient Selection*
Retrospective Studies
Survival Rate
Time Factors
Waiting Lists*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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