Heart Failure -> Heart Failure Management: -> Clinical Trials D-AB29 - LVADs, Barostim and Pacing Issues in HF management (ID 3) Abstract Plus

D-AB29-04 - Implantable Cardioverter-defibrillator And Survival In Patients With Continuous-flow Left Ventricular Assist Devices: A Systematic Review And Meta-analysis (ID 812)

 R. Chaudhary: Nothing relevant to disclose.


Background: Use of an implantable cardioverter-defibrillator (ICD) in patients with heart failure (HF) with reduced ejection fraction reduces mortality secondary to malignant arrhythmias. The role of ICD in patients with HF and continuous-flow left ventricular assist device (cfLVAD) remains controversial.
Objective: We performed a systematic literature review and meta-analysis of all published studies that examined the association between ICDs and survival in advanced HF patients with cfLVAD.
Methods: We searched PubMed, Medline, Embase, Ovid and Cochrane for studies reporting association between ICD and all-cause mortality in advanced HF patients with cfLVAD. Mantel-Haenszel risk ratio (RR) random effects model was used to summarize data. Heterogeneity was assessed using I2 statistics.
Results: Nine studies (8 retrospective and 1 prospective) with a total of 6,643 patients (ICD group = 3,554, no ICD group = 3,089) met inclusion criteria. The majority of the patients were from two large registries (UNOS and Intermacs). There was no difference in all-cause mortality between the two groups (HR 0.85; 95% CI 0.62-1.17, p=0.32). There was significant heterogeneity between studies (I2 = 59.1%; p = 0.01). Additionally, there was no significant difference in the occurrence of severe right ventricular dysfunction (HR 0.81; 95% CI 0.59-1.11, p = 0.20; I2 = 24%) and survival in bridge to transplant (HR 1.02; 95% CI 0.90-1.17, p=0.72; I2 = 7.6%) between the two groups.
Conclusion: ICD use was not associated with survival benefit in patients with cfLVAD. Future research should be directed to study the efficacy of ICDs in HF patients with cfLVAD in a dedicated randomized controlled study.