on April 30, 2009
Published online before print April 30, 2009, doi: 10.1161/CIRCHEARTFAILURE.108.814525
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Original Article |
The Efficacy of Implantable Cardioverter-Defibrillators in Heart Transplant Recipients: Results from a Multicenter Registry
1 Stanford University, Division of Cardiovascular Medicine, Stanford, CA;
2 University of Pennsylvania, Division of Cardiology, Philadelphia, PA;
3 Columbia University, Division of Cardiology, New York, NY;
4 The Cleveland Clinic Foundation, Cleveland, Ohio;St. David's Medical Center, Austin, TX;
5 Massachusetts General Hospital, Division of Cardiology, Boston, MA;
6 The Cleveland Clinic Foundation, Cleveland, OH
7 E-mail: vtsai{at}stanfordalumni.org
Background—Sudden cardiac death (SCD) among orthotopic heart transplant (OHT) recipients is an important mechanism of death following 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 SCD in high-risk heart transplant recipients.
Methods and Results—We retrospectively analyzed the records of all OHT patients who had ICD implantation between January 1995 and December 2005 at five heart transplant centers. Thirty-six patients were considered high risk for SCD. The mean age at OHT was 44±14 years, the majority being male (n=29). The mean age at ICD implantation was 52±14 years, while the average time from OHT 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 twelve 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% (8/8) of patients who received appropriate ICD therapy.
Conclusions—Use of ICDs following heart transplantation may be appropriate in select high risk patients. Further studies are needed to establish an appropriate prevention strategy in this population.
Key Words: death, sudden (if surviving, use heart arrest) • implantable cardioverter-defibrillator • orthotopic heart transplant