Key result
ICD use shows no waitlist mortality benefit in pediatric VAD patients awaiting heart transplantation.
Why the study?
Evidence guiding implantable cardioverter-defibrillator use in pediatric ventricular assist device patients awaiting heart transplant remains limited.
Does implantable cardioverter-defibrillator placement reduce waitlist composite mortality or improve transplantation rates in pediatric VAD patients?
Cohort (n=1,263)
Yes
Does implantable cardioverter-defibrillator placement reduce waitlist composite mortality or improve transplantation rates in pediatric VAD patients?
Hazard Ratio: 1.1 (95% CI 0.4–2.5)
p-value: p=.76
In pediatric VAD patients awaiting heart transplantation, ICD placement does not significantly impact waitlist mortality or transplantation rates.
No mortality benefit seen with ICDs in pediatric VAD waitlist patients; hypothesis-generating, prospective trials needed.
BACKGROUND: Ventricular arrhythmias are common in patients with end-stage heart failure requiring ventricular assist devices (VADs). Studies evaluating implantable cardioverter-defibrillator (ICD) placement in adult VAD patients show conflicting benefits. With the increasing use of VADs as a bridge to transplant in pediatric patients, evidence guiding ICD use in this population remains limited. OBJECTIVE: This study aimed to compare waitlist composite mortality (death/delisting owing to clinical deterioration) and transplantation between pediatric VAD patients with and without ICDs. METHODS: Using the Scientific Registry of Transplant Recipients data (2010-2024), we identified pediatric VAD patients (aged <18 years) listed for primary heart-alone transplant with and without ICDs, performed propensity score matching, and applied cause-specific hazard models to compare waitlist outcomes. RESULTS: Of 1263 pediatric VAD patients (83% left VAD, 15% bi-VAD, and 2.5% right VAD) listed for heart transplant, 79 (6.3%) had ICDs. There were no significant differences in race, underlying diagnosis, VAD type, inotrope use, ventilator use, or extracorporeal membrane oxygenation use. ICD patients were older at listing (15 vs 5 years; P < .0001), had higher amiodarone use (56% vs 13%; P = .0002), had greater cardiac output (3.9 vs 2.8 L/min; P = .0014), and were less often listed as United Network for Organ Sharing status 1A (84% vs 92%; P = .015). Compared with matched non-ICD patients, ICD use did not show a significant difference in waitlist mortality (hazard ratio 1.1; 95% confidence interval 0.40-2.5; P = .76) or in the likelihood of transplant (hazard ratio 1.2; 95% confidence interval 0.93-1.5; P = .17). CONCLUSION: In a national cohort of pediatric VAD patients awaiting heart transplantation, there was no difference found in mortality, clinical deterioration, and rate of transplantation in patients with ICDs compared with those without.
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Dakik et al. (2026) conducted a cohort in End-stage heart failure requiring ventricular assist devices (VADs) as a bridge to transplant (n=1,263). Implantable cardioverter-defibrillator (ICD) vs. No ICD was evaluated on Waitlist composite mortality (death/delisting owing to clinical deterioration) (HR 1.1, 95% CI 0.40-2.5, p=.76). In pediatric VAD patients awaiting heart transplantation, ICD use was not associated with a significant difference in waitlist mortality (HR 1.1; 95% CI 0.40-2.5; P=.76) compared with no ICD.
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