Effectiveness of cardiovascular implantable electronic devices with a defibrillator component therapy according to ventricular assist device implant strategy: data from the PCHF-VAD registry

    Authors

    Keywords

    heart assist devices, implantable defibrillators, heart failure

    DOI

    https://doi.org/10.15836/ccar2018.358

    Full Text

    Background: LVAD (left ventricular assist device) candidates are typically stratified according to three most typical treatment strategies – BTT (bridge to transplantation), BTD (bridge to decision) or DT (destination therapy), reflecting the acute vs. chronic state of disease, age, comorbidities and overall condition of the patient. ( 1 , 2 ) Approximately half of the European LVAD carriers are concomitantly treated with CIED-D (cardiovascular implantable electronic devices with a defibrillator component), in which we have shown substantial survival benefit from concomitant therapy. We aimed to investigate in more detail whether specific LVAD treatment strategies portended a difference in benefit from CIED-D therapy. Methods: 429 patients with continuous flow LVADs have been included in a multicentre registry formed by 12 European centres (median age 56 (IQR 46-62), 82% male), 53% also had CIED-D. Patients were analyzed according to VAD intention ( Table 1 ). Median follow-up time was 1.1 years (IQR 0.5-2.0) from the time of LVAD implant. Results: Table 1 presents the baseline characteristics of patients according to LVAD treatment strategy. Crude event rates for the primary outcome (all-cause mortality) were equally distributed among the three groups (event rates per 100 person-years): BTT: 22.4 [18.2-27.5], BTD: 23.5 [15.2-36.4], DT: 21.7 [13.7-34.5]), with similar hazard ratios for all-cause death compared to BTT group in unadjusted analysis: HR (95% CI) for BTD and DT was 1.06 (0.65-1.73), p=0.809 and 1.00 (0.60-1.65), p=0.987, respectively. CIED-D use contiguously with an LVAD significantly altered survival in the BTT and DT groups: for BTT patients, CIED-D use carried a 40% mortality reduction (p=0.017) and 65% for DT group (p=0.032). However, LVAD treatment strategy at implantation did not modify the association between CIED-D therapy and mortality reduction (interaction p=0.055). Conclusion: In this analysis, concomitant CIED-D therapy during LVAD support was associated with a reduction in mortality in patients receiving an LVAD as BTT and DT. However, neither BTT or BTD strategy modified the treatment effect of CIED-D on survival. This finding confirms the relevance of continuation of CIED-D therapy throughout the duration of LVAD support.

    Cardiologia Croatica
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    Effectiveness of cardiovascular implantable electronic devices with a defibrillator component therapy according to ventricular assist device implant strategy: data from the PCHF-VAD registry

    Extended Abstract
    Issue11-12
    Published
    Pages358-360
    PDF via DOIhttps://doi.org/10.15836/ccar2018.358
    heart assist devices
    implantable defibrillators
    heart failure

    Authors

    Nina Jakuš*ORCID
    Jasper J. BrugtsORCID
    Philippe Timmermans
    Anne-Catherine PouleurORCID
    Pawel RubisORCID
    Emeline Van CraenenbroeckORCID
    Edvinas Gaizauskas
    Sebastian GrundmannORCID
    Stephania PaolilloORCID
    Eduardo Barge-Caballero
    Domenico D’Amario
    Aggeliki Gkouziouta
    Ivo PlanincORCID
    Jesse F. VeenisORCID
    Laura HouardORCID
    Katarzyna HolcmanORCID
    Arno Gigase
    Bojan BiočinaORCID
    Hrvoje GašparovićORCID
    Lars H. LundORCID
    Andreas FlammerORCID
    Frank RuschitzkaORCID
    Davor MiličićORCID
    Maja ČikešORCID

    Full Text

    Background: LVAD (left ventricular assist device) candidates are typically stratified according to three most typical treatment strategies – BTT (bridge to transplantation), BTD (bridge to decision) or DT (destination therapy), reflecting the acute vs. chronic state of disease, age, comorbidities and overall condition of the patient. ( 1 , 2 ) Approximately half of the European LVAD carriers are concomitantly treated with CIED-D (cardiovascular implantable electronic devices with a defibrillator component), in which we have shown substantial survival benefit from concomitant therapy. We aimed to investigate in more detail whether specific LVAD treatment strategies portended a difference in benefit from CIED-D therapy. Methods: 429 patients with continuous flow LVADs have been included in a multicentre registry formed by 12 European centres (median age 56 (IQR 46-62), 82% male), 53% also had CIED-D. Patients were analyzed according to VAD intention ( Table 1 ). Median follow-up time was 1.1 years (IQR 0.5-2.0) from the time of LVAD implant. Results: Table 1 presents the baseline characteristics of patients according to LVAD treatment strategy. Crude event rates for the primary outcome (all-cause mortality) were equally distributed among the three groups (event rates per 100 person-years): BTT: 22.4 [18.2-27.5], BTD: 23.5 [15.2-36.4], DT: 21.7 [13.7-34.5]), with similar hazard ratios for all-cause death compared to BTT group in unadjusted analysis: HR (95% CI) for BTD and DT was 1.06 (0.65-1.73), p=0.809 and 1.00 (0.60-1.65), p=0.987, respectively. CIED-D use contiguously with an LVAD significantly altered survival in the BTT and DT groups: for BTT patients, CIED-D use carried a 40% mortality reduction (p=0.017) and 65% for DT group (p=0.032). However, LVAD treatment strategy at implantation did not modify the association between CIED-D therapy and mortality reduction (interaction p=0.055). Conclusion: In this analysis, concomitant CIED-D therapy during LVAD support was associated with a reduction in mortality in patients receiving an LVAD as BTT and DT. However, neither BTT or BTD strategy modified the treatment effect of CIED-D on survival. This finding confirms the relevance of continuation of CIED-D therapy throughout the duration of LVAD support.