ICD Therapy Confers No Survival Advantage in a Global LVAD Population: Insights from the Trans-Atlantic Registry on VAD and Transplant (TRAViATA)

Purpose There are conflicting data related to the use of implantable cardioverter-defibrillators (ICDs) in patients supported with continuous-flow ventricular assist devices (LVADs). Several US studies have shown a neutral effect on mortality, whereas a recent European study suggested better outcomes in LVAD patients who have an ICD. We aimed to investigate the benefit of ICDs in patients bridged to transplant with a LVAD in the TRans-Atlantic registry on VAd and TrAnsplant (TRAViATA). Methods Data from consecutive patients that received a LVAD as a bridge to transplantation between January 2008 and April 2017 were collected in 7 EU (n=299) and 3 US centers (n=225). Survival analysis was performed using Kaplan-Meier and Cox proportion hazard regression analysis. Patients were censored at time of transplantation. Results Patients with an ICD at the time of LVAD (n=350) implantation were older (56 vs. 53 years, p Conclusion In this retrospective study of LVAD patients from the EU and US ICD therapy conferred no survival advantage irrespective of geographic location. A prospective, randomized, trial of LVAD patients who have an existing ICD randomized to tachyarrhythmia therapy discontinuation is needed to validate these findings.