Aims HeartLogic, an algorithm in implanted devices, predicts heart failure (HF) episodes via a remotely monitored index, aiding proactive congestion treatment to prevent acute decompensation. This study assessed the efficacy and safety of pre-emptive HF management using the HeartLogic index. Methods and results The HeartLogic France Cohort Study is a prospective multicentre investigation involving 310 HF patients with implanted cardioverter defibrillators enrolled from 10 French centres. The HeartLogic™ index was monitored for 12 months, and when the index reached ≥16, patients were contacted to adjust HF treatment. The primary endpoint was unscheduled hospitalization for HF. An independent blinded committee adjudicated the events. A total of 309 patients (65 ± 10 years old; 83.5% male, left ventricular ejection fraction 31 ± 9%) were included in the analysis. Ischemic cardiomyopathy was present in 61.2% (n = 189) of the patients, and 52.8% (n = 163) had a cardiac resynchronization therapy device. During follow-up, 406 alerts occurred in 158 patients (1.33 alerts/patient-year), resulting in treatment modification in 39.6% of alerts. A total of 24 unplanned HF hospitalizations occurred in 19 (6.1%) patients. Sixteen (66.7%) of those hospitalizations were preceded by a HeartLogic alert, of which 14 (87.5%) triggered a drug modification before hospitalization. Eighteen deaths (5.8%) occurred, including 10 due to cardiovascular causes. An increase in creatinine ≥30% and symptomatic hypotension were reported in two patients. Hyperkalemia and hyponatremia were not observed. Conclusion Pre-emptive HF management guided by the HeartLogic index was associated with low rates of unplanned hospitalizations and adverse events over a 12-month follow-up period. Study registration ClinicalTrials.gov, ID: NCT04619888.

Abstract Aims Heart failure (HF) is a chronic disease affecting 64 million people worldwide and places a severe burden on society because of its mortality, numerous re‐hospitalizations and associated costs. HeartLogic™ is an algorithm programmed into implanted devices incorporating several biometric parameters which aims to predict HF episodes. It provides an index which can be monitored remotely, allowing pre‐emptive treatment of congestion to prevent acute decompensation. We aim to assess the impact and security of pre‐emptive HF management, guided by the HeartLogic™ index. Methods and results The HeartLogic™ France Cohort Study is an investigator‐initiated, prospective, multi‐centre, non‐randomized study. Three hundred ten patients with a history of HF (left ventricular ejection fraction ≤40%; or at least one episode of clinical HF with elevated NT‐proBNP ≥450 ng/L) and implanted with a cardioverter defibrillator enabling HeartLogic™ index calculation will be included across 10 French centres. The HeartLogic™ index will be monitored remotely for 12 months and in the event of a HeartLogic™ index ≥16, the local investigator will contact the patient for assessment and adjust HF treatment as necessary. The primary endpoint is unscheduled hospitalization for HF. Secondary endpoints are all‐cause mortality, cardiovascular death, HF‐related death, unscheduled hospitalizations for ventricular or atrial arrhythmia and HeartLogic™ index evolution over time. Blood samples will be collected for biobanking, and quality of life will be assessed. Finally, the safety of a HeartLogic™‐triggered strategy for initiating or increasing diuretic therapy will be assessed. A blind and independent committee will adjudicate the events. Conclusions The HeartLogic™ France Cohort Study will provide robust real‐world data in a cohort of HF patients managed with the HeartLogic™ algorithm allowing pre‐emptive treatment of heart failure exacerbations.

Background: Few data exist on the characteristics and outcomes of patients with arrhythmogenic right ventricular cardiomyopathy and advanced heart failure who undergo heart transplantation. Aim: To explore the pretransplant course and outcomes of patients with arrhythmogenic right ventricular cardiomyopathy after heart transplantation.Methods: This observational retrospective monocentric study included all consecutive patients with arrhythmogenic right ventricular cardiomyopathy who underwent heart transplantation during a 13-year period (2006-2019) at Pitie-Salpetriere University Hospital (Paris).Results: A total of 23 patients with arrhythmogenic right ventricular cardiomyopathy underwent heart transplantation between 2006 and 2019. The median time from diagnosis to heart transplantation was 9 years, and the median age at transplantation was 50 years. At diagnosis, half of the patients had left ven-tricular dysfunction, 59% had extensive T-wave inversion and 43% had a history of sustained ventricular tachycardia. Only five patients were involved in intensive sport activity. Indications for heart transplan-tation were end-stage biventricular dysfunction in 13 patients, end-stage right ventricular heart failure in seven and electrical storm in three. Only three patients had pulmonary hypertension, and half of the patients had atrial arrhythmias. The survival rate 1 year after heart transplantation was 74% (95% con-fidence interval 53-88%). Eight patients experienced primary graft dysfunction needing extracorporeal membrane oxygenation.Conclusions: Patients with arrhythmogenic right ventricular cardiomyopathy who eventually needed heart transplantation mostly exhibited extended disease with biventricular dysfunction at diagnosis. Intensive sport activity did not seem to be a major determinant. Advanced heart failure usually occurred late in the course of the disease. Primary graft dysfunction after heart transplantation was frequent, and should be anticipated. Additional data are needed to identify the optimal timing for heart trans-plantation and predictors of end-stage heart failure in patients with arrhythmogenic right ventricular cardiomyopathy.(c) 2022 Elsevier Masson SAS. All rights reserved.

Heart failure (HF) is a chronic disease affecting 64 million people worldwide and places a severe burden on society because of its mortality, numerous re-hospitalizations and associated costs. HeartLogic is an algorithm incorporating several biometric parameters which aims to predict HF episodes. It provides an index which can be monitored remotely, allowing preemptive treatment of congestion to prevent acute decompensation. We aim to assess the hospitalization rate of HF patients equipped with HeartLogic enabled devices. The HeartLogic French Study is an investigator-initiated, prospective, multi-centre, non-randomized study. All in all, 310 patients with a history of HF (left ventricular ejection fraction ≤ 40%; or at least one episode of clinical HF with elevated NT-proBNP ≥ 450 ng/L) and implanted with a cardioverter defibrillator enabling HeartLogic index calculation will be included across 10 French centers. The HeartLogic index will be monitored remotely on a weekly basis for 12 months and in case of HeartLogic index ≥ 16, the local investigator will contact the patient for assessment and adjust HF treatment as necessary. The primary endpoint is unscheduled hospitalization for HF. Secondary endpoints are all-cause mortality, cardiovascular death, HF-related death, and unscheduled hospitalizations for ventricular or atrial arrhythmia. Blood samples will be collected for biobanking, and quality of life will be assessed. A blind and independent committee will adjudicate the events (Fig. 1). The HeartLogic French Cohort Study will provide robust real-world data on HF hospitalization in a cohort of patients managed with the HeartLogic algorithm allowing preemptive treatment of congestion.

Aims Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy associated with a high risk of ventricular arrhythmia (VA). Current guidelines recommend beta-blockers as first-line medical therapy and if ineffective, sotalol or amiodarone. We describe our experience, as a tertiary centre for ARVC, with the effectiveness and tolerance of flecainide in addition to beta-blockers to prevent VA in ARVC. Methods and results We retrospectively included 100 consecutive ARVC patients who received flecainide with beta-blockers between May 1999 and November 2017. Treatment persistence and related side effects were assessed, as was VA-free survival on treatment, 24-h Holter monitoring and programmed ventricular stimulation (PVS) off- and on-treatment. Tolerance was good, with 10% flecainide discontinuations (lack of efficacy in six, atrial fibrillation in one, and side effects in three). No Brugada-induced electrocardiography pattern on flecainide or haemodynamic impairment was reported. Premature ventricular contraction burden at 24-h Holter monitoring was significantly decreased under treatment [median 415 (interquartile range, IQR 97-730) vs. 2370 (1572-3400) at baseline, P < 0.0001, n = 46]. Among the 33 patients with PVS under treatment, PVS was positive in 40% on-treatment vs. 94% off-treatment (P < 0.001). During a median follow-up of 47 months (IQR 23-73), 22 patients presented sustained VA on treatment, corresponding to an event rate of 5% [95% confidence interval (CI) (0.6-9)] at 1 year and 25% [95% CI (14-35)] at 5 years under treatment. No patient died. Conclusion This study suggests that flecainide and beta-blockers association is complementary to implantable cardioverter-defibrillator and catheter ablation and is safe for treating persistent symptomatic VA in patients with ARVC.

Abstract Background Heart failure (HF) is a chronic disease affecting 64 million people worldwide and places a severe burden on society because of its mortality, numerous re-hospitalizations and associated costs [1–4]. HeartLogic is an algorithm incorporating several biometric parameters which aims to predict HF episodes. It provides an index which can be monitored remotely, allowing preemptive treatment of congestion to prevent acute decompensation [5–7]. Objectives We aim to provide real-world data on the impact of pre-emptive HF management, guided by the HeartLogic index on unscheduled HF hospitalizations in a substantial cohort of patients. Methods The HeartLogic French Study is an investigator-initiated, prospective, multi-centre, non-randomized study. All in all, 310 patients with a history of HF (left ventricular ejection fraction ≤40%; or at least one episode of clinical HF with elevated NT-proBNP ≥450 ng/L) and implanted with a cardioverter defibrillator enabling HeartLogic index calculation will be included across 10 French centers. The HeartLogic index will be monitored remotely on a weekly basis for 12 months and in case of HeartLogic index ≥16, the local investigator will contact the patient for assessment and adjust HF treatment as necessary. The primary endpoint is unscheduled hospitalization for HF. Secondary endpoints are all-cause mortality, cardiovascular death, HF-related death, and unscheduled hospitalizations for ventricular or atrial arrhythmia. Blood samples will be collected for biobanking, and quality of life will be assessed. A blind and independent committee will adjudicate the events. Conclusions The HeartLogic French Cohort Study will provide robust real-world data on HF hospitalization in a cohort of patients managed with the HeartLogic algorithm allowing preemptive treatment of congestion. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific

As opposed to ventricular arrhythmias (VA), clinical implications of atrial tachyarrhythmias (AT) in arrhythmogenic right ventricular cardiomyopathy (ARVC) remain scarcely explored. This study sought to evaluate the prevalence and prognostic significance of AT in ARVC. In total, 171 patients diagnosed with ARVC between 1985 and 2018 in a single tertiary center were retrospectively included. Were defined as follows: AT: sustained atrial fibrillation, atrial flutter and focal atrial tachycardia; major adverse cardiovascular events (MAE) as a composite criterion including heart failure, cardiac assistance, transplantation, and death. After a median follow-up of 6 years (IQR 3 to 11), prevalence of AT, MAE and VA were respectively of 16%, 8% and 60%. AT occurred later in the disease course: mean age 54 ± 14.4, while 50% of patients had VA at diagnosis. Age at diagnosis (hazard-ratio [HR]: 1.05, 95% CI [1.02–1.08]; P < 0.001), RVEF (HR: 0.96, 95% CI [0.92–0.99]; P = 0.03) and LVEF (HR: 0.96; 95% CI: 0.92–0.99; P = 0.04) predicted AT occurrence in univariable analysis. Intensive sport activity was significantly associated with AT in survival and multivariable Cox analysis. AT was predictive of MAE occurrence (HR: 2.6, 95% CI [1.1–6.3]; P = 0.03). AT are common in ARVC and AT is associated with intensive sport activity and MAE. Our results mandate careful monitoring of ARVC patients with new-onset AT.

ECG late depolarization abnormality called epsilon wave (ɛ) is a major diagnostic criterion in ARVC/D patients according to Task Force. As ARVC/D induces progressive right ventricular enlargement, whether or not additional right precordial leads (X1, X2, V3R, V4R) may increase ECG diagnostic sensitivity at rest and/or during exercise has never been systematically investigated. We studied 3 groups (G) of subjects. G1: 17 propositus patients with desmosomal mutation; G2: 17 first degree relative gene carriers; G3: 20 controls. All subjects were paired between groups for age, BSA, sex and sport practice. A 16 leads ECG including additional right precordial leads X1, X2, V3R, V4R was performed in each case both at rest and at peak stress. Recordings were amplified up to 100 mm/s and 40 mm/mV and retrospectively analyzed by two investigators blinded to patient status. All subjects reached a sustained power of similar strength (160 ± 50 W) on cycloergometer. At rest, by including standard (V1, V2) and additional right precordial leads, an ɛ was shown in 14/34 patients (41%, 7 in G1, 7 in G2). Among them 4 (12%, 2 in G1, 2 in G2) showed an ɛ exclusively in at least one additional lead. At peak stress, an ɛ was noticed in 19/34 patients (56%, 12 in G1, 7 in G2). Among them, 9 patients (26%, 7 in G1, 2 in G2) showed an ɛ exclusively in at least one additional lead. In other words, in 5/34 patients (15%, all in G1) not showing any ɛ at rest, peak stress unmasked a new ɛ, exclusively in at least one additional right precordial lead. No ɛ was detected in G3, neither at rest nor at stress. By combining rest and stress test ECG, the use of additional right precordial leads X1, X2, V3R, V4R, enhances by 27% the detection of ɛ waves (major criterion), more often in propositus than in relatives, as compared to usual precordial derivations alone, and should be proposed for inclusion among ARVC/D Task Force criteria.

The role and value of electrophysiological study (EPS) for syncope in heart transplant patient has never been analyzed and described in current guidelines. To analyse if EPS was relevant in diagnostic strategy of syncope in heart transplant patient who required permanent pacemaker implantation (PPI). Between 1982 and 2012, 45 patients underwent PPI and among them EPS was performed in 9. Data were retrospectively collected including indication of pacemaker implantation, method of transplantation (biatrial versus bicaval), ECG just before PPI and results of EPS. Mean recipient age was 53 ± 19 year old and mean donor age was 50 ± 12 year old. Six patients (67%) underwent biatrial surgery and three underwent bicaval one. Mean permanent pacemaker implantation delay after transplantation was 139 ± 78 months. Six patients had PPI for paroxysmal atrioventricular block and three for sinus node disease. PPI was required according to the results of EPS only in three patients: infra-hisian delay and block in two of them with preexisting large QRS, and sinus node dysfunction in one. Electrophysiological study for syncope in heart transplant patient has a low specificity. As in general population after an inconclusive EPS, external or implantable loop recorder could be useful during follow-up to early detect bradyarrhythmias necessitating permanent pacemaker implantation.

Introduction The prognosis of pregnancy in patients with Arrhythmogenic Right Ventricular Cardiomyopathy/dysplasia (ARVC/D) is poorly documented. The aim of this study is to assess the cardiac risks during pregnancy and the impact of ARVC/D on fetuses/neonates/children. Methods We included all ARVC/D women with a history of pregnancy from the ARVC/D Pitié-Salpêtrière registry. Cardiac and obstetrical events having occurred during pregnancy/delivery/post-partum periods and neonatal data/follow-up were collected. Results Sixty pregnancies in twenty-three patients were identified between 1968 and 2016. Only two major non-fatal cardiac events (one sustained non-documented tachycardia and one ventricular tachycardia) were recorded during pregnancy in two different mothers (3% of pregnancies, 9% of mothers). None occurred during delivery or in the postpartum period. No mother developed heart failure. Beta-blocker therapy during pregnancy (n = 15) was associated with lower birthweight (2730 vs 3400 g, p = 0.004). Only two preterm deliveries occurred, unrelated to cardiac condition. Caesarean section was performed in 13% of cases. Premature sudden-death occurred in 10% (n = 5) of children before 25 years-old including two in the first year of life. Conclusion ARVC/D is associated with a low rate of major cardiac events during pregnancy and vaginal delivery appears safe. The risk of sustained ventricular arrhythmia seems poorly predictable and supports the continuation of beta-blockers during pregnancy. Major cardiac events were frequent in childhood, justifying close cardiac monitoring.

Adenosine administration after pulmonary vein (PV) isolation using radiofrequency, can unmask PVs dormant conductions and predict atrial fibrillation (AF) recurrence. Our study evaluates whether adenosine-guided pulmonary vein isolation following second-generation cryoballoon (CB-2G) ablation may improve the success rate for paroxysmal AF. One hundred and one consecutive patients scheduled for a first ablation with (CB-2G) were prospectively included between January 2013 and November 2015 in two centers. Intravenous adenosine was administered after PV isolation to unmask dormant conductions (DC) in the first 51 patients and additional applications were performed to ablate DC. The 50 next patients underwent cryoablation without adenosine testing. Symptomatic atrial fibrillation recurrence was evaluated after 3, and 12 months. Acute PV isolation was achieved in all 402 PVs of 101 patients. Moreover, 8/204 VPPV (3,9%) involving 11,7% of patients with adenosine testing showed dormant reconduction, including 1 left superior pulmonary vein, 3 left inferior pulmonary vein, 4 right superior pulmonary vein, and no right inferior pulmonary vein. After a single procedure, success rates for cryoablation were 78,5% in adenosine group and 70% in the group without adenosine (P = 0.22), with a mean follow-up of 422 days. Mean procedure duration for adenosine and without adenosine group were respectively 151 and 117 minutes (P = 0.0009), and mean fluroscopy time 36 and 33 minutes (P = 0.3). Adenosine testing after second-generation cryoballoon ablation can unmask a low rate of DC but does not improve success rate. However, this strategy increases procedural time.

OBJECTIVES The purpose of this study was to identify clinical factors associated with arrhythmic events and sudden cardiac death (SCD), and to evaluate the prognostic value of electrophysiological study (EPS) in arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) patients without implantable cardioverter-defibrillators (ICDs). BACKGROUND ARVC/D is an inherited cardiomyopathy characterized by a risk of SCD. Few studies have evaluated predictive factors of ventricular arrhythmias (VAs) in patients without ICDs. METHODS Between 2000 and 2010, all consecutive patients with ARVC/D without ICDs and with EPS at diagnosis were enrolled. Patients that received an ICD during follow-up were censored at the date of implantation, and in that case, only VAs that occurred before ICD implantation were analyzed. Risk factors for any VA event were determined by Cox regression. Patients that only experienced SCD or aborted cardiac arrest (ACA) were reported. RESULTS A total of 137 consecutive patients (78% male) diagnosed with ARVC/D without ICD were enrolled. 31% had sustained ventricular tachycardia at diagnosis. After mean follow-up of 42 +/- 31 months, 19 patients experienced an episode of sustained VA and 5 patients experienced a SCD/ACA. No event occurred in asymptomatic patients. Left ventricular ejection fraction <= 50% (p = 0.024), positive EPS (p = 0.017), and physical activity >6 h/week (p = 0.025) were independently associated with occurrence of VAs. SCD/ACA exclusively occurred in male probands with definite diagnosis and syncope. CONCLUSIONS In this cohort of ARVC/D patients without ICD, left ventricular ejection fraction <= 50%, positive EPS, and physical activity >6 h/week were independent predictors of VAs, whereas asymptomatic patients at diagnosis were at low risk. EPS predicted all VAs but had limited value to predict SCD/ACA. (C) 2018 by the American College of Cardiology Foundation.

BACKGROUND:Atrioventricular block (AVB) is common after transcatheter aortic valve replacement (TAVR) and permanent pacemaker (PPM) implantation is needed in up to 30% of patients. Main predictors of long term AVB are electrocardiographic. The purpose of this study is to assess the prognostic value of serial HV intervals measured before and after TAVR to shorten the timing of PPM implantation.METHODS:His bundle recordings were performed before (HV1), immediately after TAVR (HV2) and at day 2 for Edwards Sapien (ES) and 5 for Medtronic CoreValve (CV) (HV3). PPM indications were high degree AVB before day 5 or prolonged HV interval ≥80ms at the last recording. High degree AVB after discharge was evaluated from the pacemaker memories and ECG at 1 and 6months.RESULTS:Data were obtained in 84 patients (33% CV and 67% ES). HV values were not associated with early or late AVB. PPM were implanted in 27 patients (34%) for documented AVB (n=17, 24%), prolonged HV interval (n=9) or sick sinus syndrome (n=1). Persistent complete AVB during the procedure and postoperative high degree AVB were the only perioperative factors associated with further long term occurrence of high degree AVB (p=0.001 and p<0.001). On multivariate analysis, only postoperative high degree AVB was significant (p=0.001).CONCLUSION:Pre- and post-operative HV measurements were not correlated with late AVB after TAVR. Perioperative persistent complete AVB and postoperative high degree AVB are the only factors to predict late AVB and should be considered for the decision of PPM implantation.

Background. - Monomorphic ventricular tachycardia (MVT) is common in adults with repaired tetralogy of Fallot (TOF), and is associated with sudden cardiac death. Management of MVT is not defined, and results of catheter ablation (CA) are limited.Aims. - To evaluate long-term outcomes of MVT CA in repaired TOF.Methods. - Thirty-four patients (mean age 32 +/- 10.3 years; 59% male) with repaired TOF under went CA for symptomatic MVT between 1990 and 2012 in our centre; direct-current ablation (DCA) was used in 6%, radiofrequency followed by DCA in 29% and radiofrequency alone in 65%.Results. - Right ventricular (RV) dysfunction was present in 35% and left ventricular (LV) dysfunction in 21%. Mean numbers of clinical and induced MVTs were 1 and 2, respectively. Mean VT rate was 225 95 bpm. Ablation targeted a single site (range 1-2), which was RV outflow tract in 85%. Primary success, defined as ventricular tachycardia (VT) termination during CA and final non-inducibility, was obtained in 82%. Seven patients (21%) required redo ablation in the first 3 months (before 2004; DCA). No death related to CA occurred. Mean follow-up time was 9.5 +/- 5.2 years. Antiarrhythmic therapy was discontinued in 71%. There were two cases of sudden cardiac death and four VT recurrences. Freedom from death and arrhythmia recurrence was 94% at 5 years, 81% at 10 years and 70% at 20.years. Global survival was 91% at 20 years. Baseline LV ejection fraction < 60% was significantly associated with ventricular arrhythmia recurrence (hazard ratio 16.4, 95% confidence interval 1.8-147; P=0.01).Conclusions. - CA can safely address macroreentrant MVT in repaired TOF patients with an acceptable long-term rate of recurrence in this high-risk population. Anatomical classification of isthmuses with electroanatomical mapping provides reproducible endpoints for CA. Attention should be given to LV systolic function in risk assessment and selection of candidates for implantable cardioverter-defibrillator. (C) 2017 Elsevier Masson SAS. All rights reserved.

Radiofrequency catheter ablation (RFCA) is increasingly used in the management of ventricular tachycardia (VT) in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVC/D) but it is associated with a high level of recurrences. To determine predictors associated with VT recurrence after RFCA in ARVC/D. This study included 85 consecutive patients referred to the Pitié Salpêtrière Hospital (Paris, France) who underwent a total of 149 RFCA procedures between 2000 and 2010. Predictors of recurrence of VT following RFCA were assessed by Cox regression. The mean age of the cohort was 36±13 years, 74 (87.1%) were men and 80 (95.2%) were proband. 70 (83.3%) experienced spontaneous VT before diagnosis. 30 (58.8%) patients required ≥2 procedures. In 13 (10.7%) patients, RFCA was performed through epicardial access. Over a mean follow- up of 114±60 months, the overall freedom from VT of the 149 procedures was 79%, and 56%, at 1 and 5 years, respectively. The presence of an epsilon wave and of right ventricular (RV) dysfunction (defined by RV angiography ejection fraction <40% or right area fractional change <35% by TTE) were associated with higher level of recurrences on multivariate analysis. The cumulative freedom from VT (Figure) in patients without RV dysfunction nor epsilon wave was 86% at 1 and 5 years, which was significantly longer than those without (76% and 47% respectively, P=0.003). Absence of RV dysfunction or of an epsilon wave are strongly associated with higher success after VT RFA in ARVC/D. Patients without those risk factors should therefore be considered as good candidates for VT ablation.Download : Download high-res image (88KB)Download : Download full-size imageAbstract 0523 – Figure: Survival analysis Abstract 0523 – Figure: Survival analysis

BACKGROUND:Implantable cardioverter-defibrillators (ICDs) are recommended in patients with low ejection fraction. However, the survival benefit of ICDs in patients with end-stage heart failure listed for heart transplantation is unclear. AIM:To evaluate the ICD benefit on mortality in this population. METHODS:Three hundred and eighty consecutive patients listed for heart transplantation between 2005 and 2009 in one tertiary heart transplant centre were enrolled in a retrospective registry; 122 patients received an ICD before or within 3 months after being listed for heart transplantation (ICD group). Predictors of death on the waiting list were assessed by Cox regression. RESULTS:Overall, 15.6% of patients died while awaiting heart transplantation. Non-ICD patients presented more often haemodynamic compromise requiring mechanical circulatory support (29.1% vs. 9.8%; P<0.001), and were more likely to die while on the waiting list (19.0% vs. 8.3%; log-rank P=0.001). However, in the multivariable model, ICD did not remain an independent predictor of death. Need for mechanical circulatory support (P<0.001), low ejection fraction (P=0.001) and registration on the regular list (P=0.008) were the only independent predictors of death. Death was mainly caused by haemodynamic compromise (76.3% of deaths), which occurred more frequently in the non-ICD group (14.7% vs. 5.8%; log-rank P=0.002). Unknown/arrhythmic deaths did not differ significantly between the two groups (3.9% vs. 1.7%; log-rank P=0.21). ICD-related complications occurred in 21.4% of patients, mainly as a result of postoperative worsening of heart failure (11.9%). CONCLUSION:Haemodynamic failure appears as the main determinant of mortality in patients with end-stage heart failure awaiting heart transplantation. ICD seems to have little benefit on survival in this population.

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. The objective was to evaluate the ICD benefit on mortality in this population. 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. 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<0.0001) and were more likely to die while in the waiting list (19.0% vs 8.3%, p=0.006). However, in the multivariate model, ICD did not remain an independent predictor of death. The need for a MCS and LVEF were the only independent predictors of death (p<0.0001 and p=0.001). 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%). 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.