0494: Do implantable cardioverter defibrillators really improve survival of patients listed for heart transplantation?

Background Implantable cardioverter defibrillators (ICD) are recommended in patients with low ejection fraction. However the survival benefit of ICD in patients with end-stage heart failure listed for heart transplantation is unclear. Aim The objective was to evaluate the ICD benefit on mortality in this population. Methods 380 consecutive patients listed for heart transplantation between 2005 and 2009 in one tertiary heart transplant center were enrolled in a retrospective registry. 122 patients received an ICD before or within 3 months after registry (ICD-group). Predictors of death in the waiting list were assessed by Cox regression. Results 15.6% of patients died while awaiting heart transplantation. NonICD patients presented more often haemodynamic compromise requiring mechanical circulatory support (MCS, 34.2% vs 14.9%, p Death was mainly due to haemodynamic compromise (76.6% of deaths), which occurred more frequently in the non-ICD group (14.7% vs 5.8%, p=0.019). Unknown/arrhythmic deaths did not significantly differ between the two groups (3.9% vs 1.7%, p=0.19). ICD-related complications occurred in 21.4% of patients, mainly due post-operative worsening of heart failure (11.9%). Conclusion Haemodynamic failure appears as the main determinant of mortality in patients awaiting heart transplantation. ICD seems to have little benefit on survival in this population.