Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium.
Department of Cardiology University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
Europace. 2018 May 1;20(5):786-793. doi: 10.1093/europace/euw436.
The latest 2015 ESC Guidelines on the prevention of sudden cardiac death make a Class IIa recommendation for ICD implantation in patients listed for heart transplantation. This recommendation was based on expert consensus in view of the sparsity of data.
All patients listed for heart transplantation at the University Hospitals of Leuven from 2002 until 2014 were studied retrospectively. Exclusion criteria were age <16 years, cardiac disease other than ischaemic or dilated cardiomyopathy and re-transplantation. A total of 286 patients were included, of which 140 (49.0%) received an ICD. There was a historical increase of the time on the waiting list before transplantation (P < 0.001) together with an increase of the use of ICDs (P < 0.001) and left ventricular assist devices (LVADs) (P < 0.001). The proportion of patients reaching heart transplant remained unchanged (P = 0.700). The annual appropriate shock rate in patients with ICD was 28.0%/y on the active waiting list. Patients with ICD showed a trend to improved survival (P = 0.070). Independent predictors of mortality or removal from the transplant list because of clinical deterioration were the need for LVAD (HR 4.38, 95%CI 2.11-9.01), a history of stroke (HR 2.95, 95%CI 1.61-5.40), older age (HR 1.03, 95%CI 1.01-1.05) and a worse renal function (HR 1.15, 95%CI 1.00-1.33).
The time on the waiting list for heart transplantation significantly increased together with an increased use of device therapy in this population. The proportion of patients reaching transplant remained unchanged. This patient group is prone to life-threatening arrhythmias and the use of an ICD may improve survival.
最新的 2015 年 ESC 指南建议对接受心脏移植的患者进行 IIa 类 ICD 植入，以预防心源性猝死。该建议基于专家共识，因为数据有限。
回顾性研究了 2002 年至 2014 年期间在鲁汶大学附属医院接受心脏移植的所有患者。排除标准为年龄<16 岁、非缺血性或扩张型心肌病以及再次移植的患者。共纳入 286 例患者，其中 140 例（49.0%）植入 ICD。移植前在等待名单上的时间呈历史上升趋势（P<0.001），同时 ICD（P<0.001）和左心室辅助装置（LVAD）（P<0.001）的使用率也有所增加。达到心脏移植的患者比例保持不变（P=0.700）。在主动等待名单上，植入 ICD 的患者每年适当电击的发生率为 28.0%。植入 ICD 的患者的生存率呈上升趋势（P=0.070）。死亡或因临床恶化而从移植名单中移除的独立预测因素是需要 LVAD（HR 4.38，95%CI 2.11-9.01）、中风史（HR 2.95，95%CI 1.61-5.40）、年龄较大（HR 1.03，95%CI 1.01-1.05）和肾功能较差（HR 1.15，95%CI 1.00-1.33）。
该人群在等待心脏移植的时间明显延长，同时设备治疗的使用也有所增加。达到移植的患者比例保持不变。该患者群体易发生危及生命的心律失常，使用 ICD 可能改善生存率。
