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J Thorac Cardiovasc Surg 1995;110:532-539
© 1995 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

THE IMPACT OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS ON MORTALITY AMONG PATIENTS ON THE WAITING LIST FOR HEART TRANSPLANTATION

Vienna, Austria

Received for publication June 23, 1994. Accepted for publication Dec. 20, 1994. Address for reprints: Michael Grimm, MD, Department of Cardiothoracic Surgery, University of Vienna, Währinger Gürtel 18-20; A-1090 Vienna, Austria.

Abstract

Implantable cardioverter-defibrillators were investigated for their impact on mortality in 228 consecutive heart transplant candidates on the waiting list for transplantation (207 patients without and 21 with implantable cardioverter-defibrillator therapy). The mortality rate in 207 patients without implantable cardioverter-defibrillator therapy was 23.2% and in 21 patients with implantable cardioverter-defibrillator therapy was 4.7%. In a Cox proportional hazards model for all 228 study patients (mortality while on the waiting list: 21.5%; transplantation rate: 54.8%), the absence of an implantable cardioverter-defibrillator was only a marginally significant predictor of mortality (p = 0.079). However, the absence of an implantable cardioverter-defibrillator was a powerful predictor of mortality for a subgroup of 134 patients with high-grade ventricular arrhythmias on Holter electrocardiography (mortality while on the waiting list: 26.1%; transplantation rate: 54.5%;p = 0.022) and for a subgroup of 58 survivors of sudden cardiac death (mortality while on the waiting list: 22.4%; transplantation rate: 56.9%;p = 0.018). Implantable cardioverter-defibrillator therapy can be strongly recommended in transplant candidates with a history of sudden cardiac death. Recommendations for an expanded, prophylactic use of implantable cardioverter-defibrillator therapy in heart transplant candidates cannot be given. (J THORAC CARDIOVASC SURG 1995;110:532-9)

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