University of Colorado Denver, Aurora, CO 80045, USA.
J Heart Lung Transplant. 2010 Jul;29(7):771-6. doi: 10.1016/j.healun.2010.02.001. Epub 2010 Mar 29.
Left ventricular assist device (LVAD) use is becoming increasingly common for patients with end-stage heart failure. However, the rate of implantable cardioverter-defibrillator (ICD) shocks and the effect of these shocks on outcomes in patients with LVADs remain unknown.
Medical records were reviewed from patients with both an ICD and a LVAD from September 2000 to February 2009. The association between ICD shocks and survival while receiving device support was assessed using Cox proportional hazards modeling.
Thirty-three of 61 patients with a LVAD also had an ICD and form the basis of this report. The mean duration of LVAD support was 238 days. One or more ICD shocks were delivered to 14 patients (42%) with 8 (24%) receiving appropriate shocks for ventricular arrhythmias and 6 (18%) receiving inappropriate shocks. No patients received both appropriate and inappropriate shocks. When compared with receiving no ICD shock, receiving any ICD shock or an appropriate ICD shock were both associated with an increase in the risk of death (hazard ratio [HR] 4.5, 95% confidence interval [CI] 1.2 to 17.3, p = 0.027, and HR 5.3, 95% CI 1.3 to 22.6, p = 0.023, respectively); receipt of an inappropriate shock showed a non-significant trend for an increased risk of death (HR 3.2, 95% CI 0.7 to 16.1, p = 0.151).
ICD shocks are common after implantation of LVADs, with nearly equal numbers of appropriate and inappropriate shocks. ICD shocks are associated with higher mortality. Larger studies are needed for assessing the independent relationship of ICDs to a variety of clinical outcomes in patients with LVADs.
左心室辅助装置（LVAD）的使用对于终末期心力衰竭患者来说越来越常见。然而，植入式心律转复除颤器（ICD）的电击率以及这些电击对 LVAD 患者结局的影响仍不清楚。
对 2000 年 9 月至 2009 年 2 月间同时使用 ICD 和 LVAD 的患者的病历进行了回顾。使用 Cox 比例风险模型评估 ICD 电击与接受装置支持时的生存率之间的关系。
在 61 例接受 LVAD 治疗的患者中，有 33 例同时还装有 ICD，这是本报告的基础。LVAD 支持的平均时间为 238 天。14 例患者（42%）接受了 1 次或多次 ICD 电击，其中 8 例（24%）接受了适当的抗室性心律失常电击，6 例（18%）接受了不适当的电击。没有患者同时接受了适当和不适当的电击。与未接受 ICD 电击相比，接受任何 ICD 电击或适当的 ICD 电击均与死亡风险增加相关（风险比[HR]4.5，95%置信区间[CI]1.2 至 17.3，p=0.027 和 HR 5.3，95% CI 1.3 至 22.6，p=0.023）；接受不适当电击的患者死亡风险呈增加趋势（HR 3.2，95% CI 0.7 至 16.1，p=0.151），但无统计学意义。
LVAD 植入后 ICD 电击很常见，适当和不适当电击的数量大致相同。ICD 电击与死亡率升高相关。需要更大规模的研究来评估 ICD 在 LVAD 患者各种临床结局中的独立相关性。
