Real-world data of patients affected by advanced heart failure treated with implantable cardioverter defibrillator and left ventricular assist device: Results of a multicenter observational study.
ICD complications
ICD programming
end-stage heart failure
implantable cardioverter-defibrillator (ICD)
left ventricular assist device
Journal
Artificial organs
ISSN: 1525-1594
Titre abrégé: Artif Organs
Pays: United States
ID NLM: 7802778
Informations de publication
Date de publication:
12 Jan 2024
12 Jan 2024
Historique:
revised:
16
11
2023
received:
06
08
2023
accepted:
26
12
2023
medline:
12
1
2024
pubmed:
12
1
2024
entrez:
12
1
2024
Statut:
aheadofprint
Résumé
Left ventricular assist device (L-VAD) implantation is increasingly used in patients with heart failure (HF) and most patients also have an implantable cardioverter defibrillator (ICD). Limited data are available on the incidence of ICD therapies and complications in this special setting. The aim of this study was to analyze the real-world incidence and predictors of ICD therapies, complications and interactions between ICD and L-VAD. We conducted a multicenter retrospective observational study in patients with advanced HF implanted with ICD and a continuous-flow L-VAD, followed-up in five advanced HF centers in Northern Italy. A total of 234 patients (89.7% male, median age 59, 48.3% with ischemic etiology) were enrolled. After a median follow-up of 21 months, 66 patients (28.2%) experienced an appropriate ICD therapy, 22 patients (9.4%) an inappropriate ICD therapy, and 17 patients (7.3%) suffered from an interaction between ICD and L-VAD. The composite outcome of all ICD-related complications was reported in 41 patients (17.5%), and 121 (51.7%) experienced an L-VAD-related complication. At multivariable analysis, an active ventricular tachycardia (VT) zone and a prior ICD generator replacement were independent predictors of ICD therapies and of total ICD-related complications, respectively. Real-world patients with both L-VAD and ICD experience a high rate of ICD therapies and complications. Our findings suggest the importance of tailoring device programming in order to minimize the incidence of unnecessary ICD therapies, thus sparing the need for ICD generator replacement, a procedure associated to a high risk of complications.
Sections du résumé
BACKGROUND
BACKGROUND
Left ventricular assist device (L-VAD) implantation is increasingly used in patients with heart failure (HF) and most patients also have an implantable cardioverter defibrillator (ICD). Limited data are available on the incidence of ICD therapies and complications in this special setting. The aim of this study was to analyze the real-world incidence and predictors of ICD therapies, complications and interactions between ICD and L-VAD.
METHODS
METHODS
We conducted a multicenter retrospective observational study in patients with advanced HF implanted with ICD and a continuous-flow L-VAD, followed-up in five advanced HF centers in Northern Italy.
RESULTS
RESULTS
A total of 234 patients (89.7% male, median age 59, 48.3% with ischemic etiology) were enrolled. After a median follow-up of 21 months, 66 patients (28.2%) experienced an appropriate ICD therapy, 22 patients (9.4%) an inappropriate ICD therapy, and 17 patients (7.3%) suffered from an interaction between ICD and L-VAD. The composite outcome of all ICD-related complications was reported in 41 patients (17.5%), and 121 (51.7%) experienced an L-VAD-related complication. At multivariable analysis, an active ventricular tachycardia (VT) zone and a prior ICD generator replacement were independent predictors of ICD therapies and of total ICD-related complications, respectively.
CONCLUSIONS
CONCLUSIONS
Real-world patients with both L-VAD and ICD experience a high rate of ICD therapies and complications. Our findings suggest the importance of tailoring device programming in order to minimize the incidence of unnecessary ICD therapies, thus sparing the need for ICD generator replacement, a procedure associated to a high risk of complications.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
R Rordorf
(R)
L Pignalosa
(L)
M Casula
(M)
S Guida
(S)
A Turco
(A)
S Ghio
(S)
F Gazzoli
(F)
F Pagani
(F)
G Pisani
(G)
C Pellegrini
(C)
S Pelenghi
(S)
C Dezza
(C)
R Veronesi
(R)
E Perna
(E)
M Baroni
(M)
A Garascia
(A)
M Carbonaro
(M)
M Varrenti
(M)
D Pini
(D)
F Cannata
(F)
C Vittori
(C)
P De Filippo
(P)
G Malanchini
(G)
A Iacovoni
(A)
R Abete
(R)
A Terzi
(A)
M Senni
(M)
P Vergara
(P)
S Gulletta
(S)
G D'Angelo
(G)
P Della Bella
(PD)
Informations de copyright
© 2024 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.
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