The implantable defibrillator: An electronic bridge to cardiac transplantation

Valluvan Jeevanandam, Mark R. Bielefeld, Joseph S. Auteri, Juan A. Sanchez, Felicia A. Schenkel, Robert E. Michler, Craig R. Smith, Frank Livelli, J. Thomas Bigger, Eric A. Rose, Henry M. Spotnitz

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background. Sudden cardiac death (SCD) is common among patients awaiting heart transplantation. Medical management of SCD may fail due to lack of efficacy or adverse side effects. The implantable cardioverter-defibrillator (ICD) may extend patient survival until a donor heart is available. Methods and Results. We reviewed 16 patients listed for transplantation between November 1988 and October 1991 who underwent ICD implantation for ventricular arrhythmias refractory to medical management. Mean age was 51.4±11.4 years (range, 19-66 years), mean ejection fraction was 15.4±3.0% (range, 10-21%), and underlying cardiomyopathy was ischemic (12 patients), valvular (one patient), or dilated (three patients). There was no mortality from ICD insertion. Fourteen patients were discharged before transplantation, and two patients remained in the hospital until transplantation. Twelve patients underwent transplantation after a mean of 155.7±113.7 days (range, 3-319) on the transplant list. The ICD delivered shocks for tachyarrhythmia associated with near syncope in 15 of 16 patients. ICD shocks numbered >10 in five patients, 5-9 in three patients, and 1-4 in seven patients. There was no morbidity or mortality attributed to patch electrode removal. Conclusions. We conclude that the ICD can be implanted with minimal morbidity in transplant candidates, allowing the patients to be ambulatory and to leave the hospital while awaiting heart transplantation. In patients at risk of SCD, the ICD is an effective electronic bridge to transplantation.

Original languageEnglish (US)
JournalCirculation
Volume86
Issue number5 SUPPL.
StatePublished - Nov 1992
Externally publishedYes

Fingerprint

Implantable Defibrillators
Heart Transplantation
Transplantation
Sudden Cardiac Death
Shock
Morbidity
Transplants
Mortality
Syncope
Cardiomyopathies
Tachycardia

Keywords

  • Arrhythmias
  • Cardiomyopathy
  • Drugs, antiarrhythmic
  • Sudden cardiac death

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Jeevanandam, V., Bielefeld, M. R., Auteri, J. S., Sanchez, J. A., Schenkel, F. A., Michler, R. E., ... Spotnitz, H. M. (1992). The implantable defibrillator: An electronic bridge to cardiac transplantation. Circulation, 86(5 SUPPL.).

The implantable defibrillator : An electronic bridge to cardiac transplantation. / Jeevanandam, Valluvan; Bielefeld, Mark R.; Auteri, Joseph S.; Sanchez, Juan A.; Schenkel, Felicia A.; Michler, Robert E.; Smith, Craig R.; Livelli, Frank; Bigger, J. Thomas; Rose, Eric A.; Spotnitz, Henry M.

In: Circulation, Vol. 86, No. 5 SUPPL., 11.1992.

Research output: Contribution to journalArticle

Jeevanandam, V, Bielefeld, MR, Auteri, JS, Sanchez, JA, Schenkel, FA, Michler, RE, Smith, CR, Livelli, F, Bigger, JT, Rose, EA & Spotnitz, HM 1992, 'The implantable defibrillator: An electronic bridge to cardiac transplantation', Circulation, vol. 86, no. 5 SUPPL..
Jeevanandam V, Bielefeld MR, Auteri JS, Sanchez JA, Schenkel FA, Michler RE et al. The implantable defibrillator: An electronic bridge to cardiac transplantation. Circulation. 1992 Nov;86(5 SUPPL.).
Jeevanandam, Valluvan ; Bielefeld, Mark R. ; Auteri, Joseph S. ; Sanchez, Juan A. ; Schenkel, Felicia A. ; Michler, Robert E. ; Smith, Craig R. ; Livelli, Frank ; Bigger, J. Thomas ; Rose, Eric A. ; Spotnitz, Henry M. / The implantable defibrillator : An electronic bridge to cardiac transplantation. In: Circulation. 1992 ; Vol. 86, No. 5 SUPPL.
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AB - Background. Sudden cardiac death (SCD) is common among patients awaiting heart transplantation. Medical management of SCD may fail due to lack of efficacy or adverse side effects. The implantable cardioverter-defibrillator (ICD) may extend patient survival until a donor heart is available. Methods and Results. We reviewed 16 patients listed for transplantation between November 1988 and October 1991 who underwent ICD implantation for ventricular arrhythmias refractory to medical management. Mean age was 51.4±11.4 years (range, 19-66 years), mean ejection fraction was 15.4±3.0% (range, 10-21%), and underlying cardiomyopathy was ischemic (12 patients), valvular (one patient), or dilated (three patients). There was no mortality from ICD insertion. Fourteen patients were discharged before transplantation, and two patients remained in the hospital until transplantation. Twelve patients underwent transplantation after a mean of 155.7±113.7 days (range, 3-319) on the transplant list. The ICD delivered shocks for tachyarrhythmia associated with near syncope in 15 of 16 patients. ICD shocks numbered >10 in five patients, 5-9 in three patients, and 1-4 in seven patients. There was no morbidity or mortality attributed to patch electrode removal. Conclusions. We conclude that the ICD can be implanted with minimal morbidity in transplant candidates, allowing the patients to be ambulatory and to leave the hospital while awaiting heart transplantation. In patients at risk of SCD, the ICD is an effective electronic bridge to transplantation.

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