Key result
In patients with advanced heart failure and an L-VAD, 28.2% experienced appropriate ICD therapy and 17.5% had ICD-related complications over a median 21 months.
Why the study?
Limited data are available on the incidence of ICD therapies and complications in patients with advanced heart failure and a left ventricular assist device.
Observational (n=234)
Yes
Answers are grounded in this paper and cite their sources.
Patients with both L-VAD and ICD experience high rates of ICD therapies and complications, highlighting the need for tailored device programming to minimize unnecessary interventions.
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: 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: 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: 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.
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Rordorf et al. (2024) conducted an observational in advanced heart failure (n=234). Implantable cardioverter defibrillator and left ventricular assist device was evaluated on appropriate ICD therapy. In patients with advanced heart failure and an L-VAD, 28.2% experienced appropriate ICD therapy and 17.5% had ICD-related complications over a median 21 months.
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