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Cardiac implantable electronic devices with a defibrillator component and all-cause mortality in left ventricular assist device carriers: results from the PCHF-VAD registry
- Source :
- European journal of heart failure, European Journal of Heart Failure, 21(9), 1129-1141. Wiley-Blackwell, European journal of heart failure, Vol. 21, no. 9, p. 1129-1141 (2019)
- Publication Year :
- 2019
- Publisher :
- Oxford University Press, 2019.
-
Abstract
- AIMS: To compare characteristics of left ventricular assist device (LVAD) recipients receiving a cardiac implantable electronic device (CIED) with a defibrillator component (implantable cardioverter-defibrillator and cardiac resynchronization therapy with defibrillation, CIED-D) vs. those without one, and to assess whether carrying such a device contiguously with an LVAD is associated with outcomes. METHODS AND RESULTS: Overall, 448 patients were analysed (mean age 52 ± 13 years, 82% male) in the multicentre European PCHF-VAD registry. To account for all active CIED-Ds during ongoing LVAD treatment, outcome analyses were performed by a time-varying analysis with active CIED-D status post-LVAD as the time-varying covariate. At the time of LVAD implantation, 235 patients (52%) had an active CIED-D. Median time on LVAD support was 1.1 years (interquartile range 0.5-2.0 years). A reduction of 36% in the risk of all-cause mortality was observed in patients with an active CIED-D [hazard ratio (HR) 0.64, 95% confidence interval (CI) 0.46-0.91; P = 0.012), increasing to 41% after adjustment for baseline covariates (HR 0.59, 95% CI 0.40-0.87; P = 0.008) and 39% after propensity score adjustment (HR 0.61, 95% CI 0.39-0.94; P = 0.027). Other than CIED-D, age, LVAD implant as redo surgery, number of ventricular arrhythmia episodes and use of vasopressors pre-LVAD were remaining significant risk factors of all-cause mortality. Incident ventricular arrhythmias post-LVAD portended a 2.4-fold and 2.6-fold increased risk of all-cause and cardiovascular death, respectively; carrying an active CIED-D remained associated with a 47% and 43% reduction in these events, respectively. CONCLUSIONS: In an analysis accounting for all active CIED-Ds, including those implanted during LVAD support, carrying such a device was associated with significantly better survival during LVAD support. ispartof: EUROPEAN JOURNAL OF HEART FAILURE vol:21 issue:9 pages:1129-1141 ispartof: location:England status: published
- Subjects :
- Male
Advanced heart failure
medicine.medical_treatment
Left ventricular assist device
030204 cardiovascular system & hematology
0302 clinical medicine
Interquartile range
Cause of Death
Registries
Cardiac resynchronization therapy
Cardiac implantable electronic device
Hazard ratio
Middle Aged
Defibrillators, Implantable
Europe
Left ventricular assist devices
10209 Clinic for Cardiology
Ventricular arrhythmia
Cardiology
Female
Cardiology and Cardiovascular Medicine
Adult
medicine.medical_specialty
Defibrillation
610 Medicine & health
2705 Cardiology and Cardiovascular Medicine
Implantable cardioverter-defibrillator
03 medical and health sciences
Implantable cardioverter-defibrillators
Mortality
Internal medicine
medicine
Humans
Cardiac Resynchronization Therapy Devices
Aged
Proportional Hazards Models
Heart Failure
business.industry
advanced heart failure
cardiac implantable electronic device
cardiac resynchronization therapy
implantable cardioverter-defibrillators
left ventricular assist devices
mortality
ventricular arrhythmia
equipment and supplies
medicine.disease
Confidence interval
Death, Sudden, Cardiac
Case-Control Studies
Ventricular assist device
Heart failure
Propensity score matching
Heart-Assist Devices
Human medicine
business
Subjects
Details
- Language :
- English
- ISSN :
- 11291141 and 13889842
- Database :
- OpenAIRE
- Journal :
- European journal of heart failure, European Journal of Heart Failure, 21(9), 1129-1141. Wiley-Blackwell, European journal of heart failure, Vol. 21, no. 9, p. 1129-1141 (2019)
- Accession number :
- edsair.doi.dedup.....fd521d85d1ba47c1a47da6578f5d455f