Implantable Cardioverter-Defibrillator Implantation as a Bridge to Cardiac Transplantation

Implantable cardioverter-defibrillators (ICDs) have been shown to reduce sudden cardiac death in select patients with impaired left ventricular function. However, consensus guidelines on ICD use have not historically addressed patients waiting for heart transplantation, and further evidence is needed to broaden and strengthen current recommendations. The objective of the present study was to review all patients listed for heart transplantation at a single institution and evaluate the impact of ICD implantation while waiting. All consecutive patients listed for heart transplantation at the Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, from 1995 to July 2006, were included in the study (n = 124). We observed 12 deaths while waiting among patients listed for transplantation (10%), with all deaths occurring in the non-ICD patients. In patients who did have an ICD prior to transplantation, 17% received appropriate defibrillation therapy while awaiting transplantation, and 3 of 12 patients in the non-ICD population who died while waiting died suddenly, suggesting that ICDs could be used as a "bridge to transplantation" in patients with refractory heart failure who are to be listed for heart transplantation.