Key result
In LVAD recipients, having a CRT-D compared to an ICD only was associated with a significantly higher rate of generator replacement (28.2% vs 18.3%, P=0.0006).
Why the study?
Limited data exist regarding complication rates of ICD and CRT-D devices in patients with LVADs.
Does continued CRT-D therapy compared to ICD only increase device-related procedures and complications in LVAD recipients?
Cohort (n=537)
Yes
Does continued CRT-D therapy compared to ICD only increase device-related procedures and complications in LVAD recipients?
In LVAD recipients, continued CRT-D therapy is associated with more frequent generator replacements and a trend toward more complications compared to ICD only, without affecting long-term survival.
Higher generator replacement rates with CRT-D in LVAD recipients warrant caution in device selection; leaves open net benefit versus ICD alone.
Background Limited data exist regarding complication rates of implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy devices (CRT-D) in patients with left ventricular assist devices (LVAD). Objective We describe the incidence and characteristics of ICD- and CRT-D-related procedures and complications in a multicenter LVAD cohort. Methods A total of 537 LVAD patients with a pre-existing ICD or CRT-D from 5 centers were included. Details on device type, device therapies, procedural complications, and long-term survival were analyzed. Results Of 537 patients, 280 had a CRT-D and 257 had ICD only. During a median follow-up of 538 days, 126 patients underwent generator replacement with significantly higher rate in the CRT group (79 [28.2%] vs 47 [18.3%], P = .0006). Device-related complications occurred in 36 (13%) CRT-D and 20 (8%) ICD patients ( P = .06). Incidence of pocket hematoma (3.2% vs 2.7%), infection (4.3% vs 1.6%), and lead malfunction (3.1% vs 2.8%) was similar in both groups, with no effect of device complication on long-term survival (log-rank P = .7). There was a higher incidence of post-LVAD antitachycardia pacing for ventricular arrhythmias in the CRT-D group compared to the ICD group (35% vs 26%, P = .03). Conclusion Cardiac implantable electronic device–related procedures are common in LVAD patients. Compared to ICD only, continued CRT-D therapy post-LVAD results in a significantly higher number of generator changes and a trend towards higher device- or lead-related complications. Device-related complications were not associated with reduced survival.
No takes yet. Share an insight, caveat, or question.
Ravichandran et al. (2021) conducted a cohort in Left ventricular assist device (LVAD) recipients with pre-existing ICD or CRT-D (n=537). CRT-D vs. ICD only was evaluated on Generator replacement (p=.0006). In LVAD recipients, having a CRT-D compared to an ICD only was associated with a significantly higher rate of generator replacement (28.2% vs 18.3%, P=0.0006).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: