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Original Articles

The Efficacy of Implantable Cardioverter-Defibrillators in Heart Transplant Recipients

Results From a Multicenter Registry

Vivian W. Tsai, MD; Joshua Cooper, MD; Hasan Garan, MD; Andrea Natale, MD; Leon M. Ptaszek, MD, PhD; Patrick T. Ellinor, MD, PhD; Kathleen Hickey, PhD; Ross Downey, MD; Paul Zei, MD; Henry Hsia, MD; Paul Wang, MD; Sharon Hunt, MD; François Haddad, MD and Amin Al-Ahmad, MD

From the Division of Cardiovascular Medicine (V.W.T., P.Z., H.H., P.W., S.H., F.H., A.A.L.), Stanford University, Stanford, Calif; Division of Cardiology (J.C.), University of Pennsylvania, Philadelphia, Pa; Division of Cardiology (H.G., K.H.), Columbia University, NY; Division of Cardiology (L.M.P., P.T.E.), Arrhythmia Service (P.T.E.), Massachusetts General Hospital, Boston, Mass; The Cleveland Clinic Foundation (R.D.), Cleveland, Ohio; and St. David’s Medical Center (A.N.), Austin, Tex.

Correspondence to Vivian Tsai, MD, CVRC, 300 Pasteur Drive, Stanford, CA 94305-5406. E-mail vtsai{at}stanfordalumni.org

Received August 28, 2008; accepted February 12, 2009.

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.

Key Words: sudden death • implantable cardioverter-defibrillator • orthotopic heart transplant

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