植入型心律转复除颤器在心脏性猝死一级和二级预防中的应用

目的比较植入型心律转复除颤器（ICD）在心脏性猝死一级及二级预防中的治疗作用。方法对2005年1月至2009年6月符合ICD一级预防及二级预防标准并在我院植入ICD的患者进行随访。ICD的诊断设置室性心动过速（VT）、快速室性心动过速（FVT）及心室颤动（VF）3个工作区,治疗设置抗心动过速起搏（ATP）、低能量同步转复（CV）和高能量除颤（DF）。术后每3—6个月随访1次,利用程控仪获取ICD储存资料,了解患者心律失常发作情况以及ICD的诊断和治疗情况。结果共随访了40例患者,一级预防及二级预防各20例,平均随访时间一级预防组（12．2±7．6）个月,二级预防组（14．6±9．6）个月。随访过程中共13例患者发生了VF事件,其中一级预防组4例,二级预防组9例,21例患者发生了VT事件,其中一级预防组9例,二级预防组12例,统计学分析显示两组患者间VF及VT事件发生率差异无统计学意义。VT发生频率（VTfrenquency）在一级预防组为4．465次／月,二级预防组为26．16次／月（P〈0．001）。VT发作时间（VTduration）在一级预防组为（25．6±15．6）s,二级预防组为（78．1±58．7）s（P〈0．001）。一级预防组中9例患者ICD记录有持久性VT事件,其中由ATP终止6例,CV终止3例。4例患者有VF事件,均DF成功,二级预防组中12例患者ICD记录有持久性VT事件,其中由ATP终止7例,CV终止5例。9例患者有VF事件,均DF成功。结论二级预防的患者室性心律失常发作频率及发作时间均明显高于一级预防的患者,但因样本量较小,两组患者间因VT或VF接受ICD治疗的比例差异无统计学意义。     

埋藏式心脏转复除颤器的临床应用单中心经验

目的评估本中心置入埋藏式心脏转复除颤器(ICD)患者的室性心律失常[室性心动过速(VT)/心室颤动(VF)]发生及治疗状况。方法连续入选本中心于2004年1月至2014年6月置入ICD或CRTD并规范随访的患者,收集术前资料、术后VT/VF发生及治疗情况。结果共分析76例患者,其中一级预防32例,二级预防44例,43例(56.6%)存在严重心功能不全(左室射血分数0.35)。随访13个月至10年,无一例死于VT/VF。22例(28.9%)发生ICD恰当治疗,15例(19.7%)发生不恰当治疗。一级预防患者VT/VF发生率低于二级预防组(9.4%vs 43.2%,P=0.001)。冠心病亚组一级预防与二级预防VT/VF发生率无差别(20%vs 55.6%,P=0.21),而扩张型心肌病组一级预防低于二级预防(8%vs 50%,P=0.009)。不同病因的二级预防患者VT/VF发生率无差异。单腔与双腔(包括三腔)ICD的不恰当治疗率分别是28.1%vs 13.6%(P=0.11)。结论 ICD能有效预防室性心律失常性死亡,二级预防及缺血性心肌病患者ICD恰当治疗率高,而一级预防患者中扩张型心肌病VT/VF发生率较低。双腔ICD的不恰当治疗率较单腔有减少的趋势。     

植入型心律转复除颤器对缺血性心肌病患者病死率的影响

目的:缺血性心肌病伴左心室功能不全[射血分数(EF)<40%]和恶性室性心律失常的患者预后不良,研究比较植入型心律转复除颤器(ICD)和传统药物治疗对这组患者病死率的影响。方法:回顾性分析2002年1月至2006年3月明确诊断为缺血性心肌病伴左心室功能不全(EF<40%)及恶性室性心律失常的患者152例,其中男性97例,女性55例,平均年龄(58.2±23.4)岁,其中ICD植入患者15例(A组),传统药物治疗患者137例(B组),随访(14±3)个月,主要终点事件为任何原因的死亡。结果:A组患者只有1例(6.7%)死亡,但对其ICD事件进行回顾性分析证实死亡为非恶性室性心律失常所致。B组患者死亡19例(13.9%),其中6例患者死于恶性室性心律失常。2组患者的病死率差异无显著性(P>0.05)。但对ICD植入患者的程控发现ICD共成功纠正心室颤动(VF)发作21次,持续性室速(VT)发作65次。结论:本研究提示ICD可降低缺血性心肌病患者恶性室性心律失常导致的猝死。     

植入型心律转复除颤器对慢性心力衰竭心脏性猝死的一级预防

目的评价植入型心律转复除颤器（ICD）在慢性心力衰竭患者心脏性猝死一级预防中的治疗作用。方法对2005年1月至2008年12月符合ICD一级预防标准并植入ICD的患者进行随访。ICD的诊断设置室性心动过速（VT）、心室颤动（VF）两个工作区,治疗设置抗-tk,动过速起搏（ATP）、低能量同步转复（CV）和高能量除颤（DF）。术后患者常规给予抗心律失常药物。每3～6个月随访1次,利用程控仪获取ICD储存资料,了解患者心律失常发作情况以及ICD的诊断和治疗是否准确,及时调整相关参数并处理ICD故障。结果共随访了22例患者,平均随访（12．8±8．6）个月。共有10例患者记录到ICD治疗事件。10例患者ICD记录到持续性VT事件,其中由ATP终止6例,CV终止4例。4例患者有VF事件,均1次DF成功。2例ICD将快速心室率心房颤动（AF）识别为VF并进行放电治疗并转复房颤。结论ICD在慢性心力衰竭患者心脏性猝死一级预防中的治疗效果是肯定的,ICD联合抗心律失常药物能有效治疗恶性室性心律失常,预防心脏性猝死。     

植入型心律转复除颤器在致心律失常性右心室心肌病患者中的应用

目的 总结阜外心血管病医院应用植入型心律转复除颤器(ICD)治疗致心律失常性右心室心肌病(ARVC)的经验.方法 入选我院2004年3月至2012年3月确诊并植入ICD的ARVC患者,收集临床资料,进行常规电话及门诊随诊.结果 共18例患者[男12例,女6例,平均年龄(46.4±13.8)岁]入选,平均随访(46.6±30.5)个月,有6例患者出现了111次室性心动过速(VT)/心室颤动(VF)事件,其中仅1次VF事件,其余均为VT事件,其中3例患者术后共出现了7次电风暴.ICD治疗组中的C反应蛋白(CRP)明显高于ICD未治疗组.111次VT/VF事件中,12次经电除颤终止心动过速,其余均通过抗心动过速起搏(ATP)终止了心动过速.结论 ARVC患者ICD植入后的VT/VF事件以VT为主,多数可经ATP终止;出现电风暴的ARVC患者易反复发作恶性心律失常;CRP可能对ICD治疗具有预测价值.     

植入带有家庭监测系统的心律转复除颤器20例临床随访及评价

目的 对我院20例植入带有家庭监测系统的心律转复除颤器(ICD)患者进行门诊及家庭监测系统随访.探讨家庭监测系统对植入ICD患者电极导线及脉冲发生器安全性评价及对包括房性心律失常、恶性室性心律失常在内的临床事件的早期发现及干预效果.方法 收集20例2010年6月至2011年11月在我院植入带有家庭监测系统的ICD患者的临床特征、植入信息及通过家庭监测网站系统和门诊常规随访结果,将随访结果进行回顾性总结分析.结果 20例患者随访117 ～ 644(332.90±175.25)d,在随访过程中,累计有6例患者有室性心律失常事件发生,其中有5例患者成功接受ICD,占全部患者的25％.1例患者因快速心房颤动(房颤)被误识别为心室颤动(VF)而进行电除颤.5例成功接受ICD治疗的患者中有1例患者曾因房性心动过速(房速)误识别为室性心动过速(VT)而进行电除颤,误识别及误放电的发生率为9.1％.除去误识别及误放电外,所有患者共发作室上性心动过速(SVT) 238次,VT/VF 20次,其中VT 7次(35％),VF 13次(65％).VT发作均由抗心动过速起搏治疗(ATP)终止,共发放26阵ATP,成功转复7次,ATP转复率27％,VT治疗成功率100％.VF导致充电开始13次,其中10次在ICD结束充电前自行终止,3次在放电治疗后成功转复,ICD治疗成功率100％.20例患者中无1例死亡.结论 通过家庭监测网络系统,不仅可以对ICD患者电极导线及脉冲发生器的正常运转进行有效监控,还可以在患者出现自觉症状前尽早发现患者潜在的恶性心律失常事件和心功能的恶化,并给予及时处理,以避免ICD事件的发生和治疗,从而给患者带来更大的获益.     

植入型心律转复除颤器治疗34例随访

目的:对我院37例安装植入型心律转复除颤器患者中34例长期随访(3例失访)。方法:将随访结果进行回顾性总结分析。结果:随访时间4～69个月,平均(24.7±18)个月。29例成功接受植入型心脏复律除颤器(ICD)治疗,占全部患者的85.3%。共发作恶性室性心律失常事件587次,其中313次为非持续性,均自行终止。接受ICD治疗的274次中室性心动过速(VT)238次,占86.9%。心室颤动(VF)36次,占13.1%。VT由抗心动过速起搏(ATP)终止212次,由低能量(2～15J)转复终止23次。有3次VT在ATP治疗时转为VF,由高能量除颤(DF)终止。VF经高能量除颤36次,全部一次成功。5例患者因房性心动过速(房速)或心房颤动(房颤)被误识别为VT而发放电击。34例中有3例死亡,1例死于急性心肌梗死,1例死于心力衰竭,1例死因不明。结论:ICD可以有效的终止VT、VF,是防治心源性猝死的有效治疗手段。     

心脏性猝死的预防及我国埋藏式心律转复除颤器应用状况

目的通过对全国部分医院的回顾性调查研究,了解我国埋藏式心律转复除颤器(ICD)使用状况.方法回顾性分析了1996年1月18日到2003年1月31日,来自82家医院的173例ICD患者的临床情况,了解其基础病因、心律失常类型、ICD对心律失常的治疗情况以及ICD的并发症.结果 173例植入ICD患者,其中115例(66.5%)有各种器质性心脏病,以冠心病为最常见.植入患者中室性心动过速(VT) 106例(61.3%),心室颤动(VF) 34例(19.6%),VT合并VF 33例(19.1%).在平均随访27.8个月(1～86个月)中,82例 (47.4%)发生VT和/或VF,并接受ICD成功治疗;73.04%的VT通过抗心动过速起搏(ATP)终止;VF除颤成功率为100%;误放电率为2.0%.术后并发症发生率为2.3%,随访期间共有11例患者死亡,占6.4%.结论本研究的有限数据表明ICD治疗对我国患者带来的好处,但其应用尚处于起步阶段.     

埋藏式心脏转复除颤器放电无效事件原因分析与处理

目的:分析3例埋藏式心脏转复除颤器(implantable cardioverter defibrillator,ICD)患者14次放电无效的临床特点。方法:回顾2008年至今42例ICD置入患者中3例放电无效的临床资料。结果:①38例患者完成规律随访,其中3例出现14次放电无效,男性2例,女性1例,平均年龄38~67岁,长Q-T综合征1例,缺血性心肌病2例,单腔ICD 1台,双腔ICD 1台,CRT-D 1台,均为二级预防,平均随访8~38个月;②ICD正确识别室性心律失常并行放电治疗共55次,低能量转复(CV)治疗38次,成功26次,转复成功率68.4%,高能量除颤(DF)治疗17次,成功15次,除颤成功率88.2%,其中放电无效事件14次,发生率25.5%。③1例CRT-D患者6个月内发生17次放电事件,其中2次快速室性心动过速(FVT)事件予10J转复无效,增加能量后成功转复,经积极综合治疗室性心律失常事件虽明显减少且三磷酸腺苷(ATP)有效,但首次放电9个月后因顽固心力衰竭死亡;1例经左上腔置入单腔ICD患者出现血流动力学稳定的3阵室性心动过速(VT)事件,但频率进入心室颤动(VF)诊断区直接放电6次均无效,经提高VF诊断频率、延长VT识别间期、改变除颤极性及加量应用美托洛尔等处理,随访1年余3次VT/FVT事件经ATP治疗成功;1例双腔ICD患者出现血流动力学稳定的3阵VT事件,抗心动过速起搏(ATP)失败后放电6次均无效,经加强ATP及药物治疗,随访6个月VT事件减少,且ATP治疗有效,未再放电。结论:ICD存在其局限性,原发病的治疗及药物治疗仍然是防治心律失常的基石,放电无效现象是严重并发症,除颤阈值测定对特殊个体可能是必要的,优化程控予以矫正至关重要,必要时仍需手术调整。     

具有埋藏式心脏转复除颤器植入适应证患者的调查与随访

目的调查符合植入埋藏式心脏转复除颤器(ICD)适应证患者的基础病因、临床特征、治疗选择及预后。方法入选本院符合ICD适应证的152例患者,收集其基本资料及相关病史,记录入院期间检查结果及治疗情况,并对死亡率和恶性室性心律失常发生率进行随访。结果符合ICD适应证患者以缺血性心脏病最多;ICD心脏性猝死一级预防适应证患者明显多于二级预防适应证患者(118 vs 34);二级预防适应证患者植入ICD的比例明显多于一级预防适应证患者[44.1%(15/34)vs 9.3%(11/118)];随访结束发现植入ICD/CRT-D患者的全因死亡率要明显低于未植入ICD/CRT-D患者[0%vs 17.5%(20/114)](P<0.05)。结论 ICD/CRT-D能减低ICD适应证患者的全因死亡率,然而临床上ICD作为心脏性猝死预防的实际应用要远远低于其指征范围。     

Significance of inducible ventricular flutter/fibrillation in risk stratification in patients with coronary artery disease

BACKGROUND: Although inducible ventricular fibrillation (VF) has been used as an indication for prophylactic implantation of cardioverter-defibrillators (ICDs) in patients with coronary artery disease (CAD), the significance of inducible VF remains controversial. METHODS: Among 364 CAD patients who underwent electrophysiologic (EP) study for risk stratification, 23 patients, 12 without any history of VF or cardiac arrest (group A) and 11 with previously documented VF or cardiac arrest (group B), exhibited inducible ventricular flutter (VFL) or VF and subsequently underwent ICD implantation. Additionally, 11 CAD patients without previous VF or cardiac arrest, who had no inducible ventricular tachyarrhythmias but received an ICD, were included for comparison (group C). RESULTS: During 2 years of follow-up, 1 (8%), 5 (45%), and 1 (9%) patients had appropriate ICD shocks in groups A, B, and C, respectively. The survival free from appropriate ICD shocks was significantly lower in group B compared to groups A and C (p<0.05). There were no significant differences in age, sex, ejection fraction (EF), or induction protocol between groups A and B or between groups A and C. CONCLUSIONS: In CAD patients with inducible VFL/VF, patients without any history of VF or cardiac arrest had significantly lower incidence of appropriate ICD shocks when compared to those with such clinical events. Conversely, in CAD patients without any history of VF or cardiac arrest, incidence of appropriate ICD shocks was similar regardless of inducible VFL/VF. Inducible VFL/VF is therefore not useful as an indication for prophylactic ICD implantation in this patient population.     

Comparison of event rates and survival in patients with unexplained syncope without documented ventricular tachyarrhythmias versus patients with documented sustained ventricular tachyarrhythmias both treated with implantable cardioverter-defibrillators

Patients with unexplained syncope and inducible ventricular tachyarrhythmias during electrophysiologic testing have an increased cardiac mortality rate. We compared event rates and survival of 178 patients with unexplained syncope and no documented ventricular arrhythmias (syncope group) versus 568 patients with documented sustained ventricular tachycardia (VT or fibrillation (VF) (VT/VF group) treated, as part of a lead (Ventritex TVL) investigation, with similar implantable cardioverter-defibrillators (ICDs) capable of extensive data storage. The 2 groups shared similar clinical characteristics. The mean follow-up was 11 months for the syncope group and 14 months for the VT/VF group. The mean time from device implantation to first appropriate therapy was similar in the 2 groups (109 +/- 140 vs 93 +/- 131 days, p = 0.40). Actuarial probability of appropriate ICD therapy was 49% and 55% at 1 and 2 years, respectively, in syncope group and 49% and 58% in VT/VF group (p = 0.57). Recurrent syncope was associated with ventricular tachyarrhythmias in 85% and 92% of the syncope group and VT/VF group, respectively (p = 0.54). At 2 years, actuarial survival was 91% in the syncope group and 93% in VT/VF group (p = 0.85). We conclude that patients treated with ICD with unexplained syncope and induced VT/VF have an equally high incidence of appropriate ICD therapy and low mortality compared with similar patients with documented VT/VF. These findings, plus the high association between recurrent syncope and ventricular arrhythmias, indicate that VT/VF are likely etiologies in selected patients with unexplained syncope and support ICD therapy in such cases.     

Prevalence, predictors, and mortality significance of the causative arrhythmia in patients with electrical storm

INTRODUCTION: Electrical storm (ES) is characterized by either refractory ventricular tachycardia (VT) or ventricular fibrillation (VF). However, little is known about the prevalence, predictors, and mortality implications of the causative arrhythmia in ES. We sought to assess the prevalence, predictors, and survival significance of VT and VF as the causative arrhythmia of ES in implantable cardioverter defibrillator (ICD) patients. METHODS AND RESULTS: Consecutive patients from January 2000 to December 2002 who presented to the ICD clinic with > or = 2 separate ventricular arrhythmic episodes requiring shock within 24 hours were included in the study. ICD interrogation confirmed the number of shocks and provided electrograms for interpretation of the causative arrhythmia. Patients were grouped as VF or VT according to the causative arrhythmia. Their prevalence, predictors, and mortality rates were compared. Of 2,028 patients assessed in the ICD clinic, 208 (10%) presented with ES. VF was the cause of ES in 99 of 208 patients, for an overall prevalence of 48%. Original ICD indication, coronary artery disease, and amiodarone therapy were predictive for the causative arrhythmia. There was no mortality difference between the VT and VF groups; however, both groups had significantly increased mortality compared to a control ICD population without ES. CONCLUSION: VF is the causative arrhythmia for a sizable proportion of patients with ES. The initial ICD indication, coronary artery disease, and amiodarone therapy are predictors of the causative arrhythmias in ES. There does not appear to be any mortality difference between ES patients with VT and VF, but mortality is increased in patients with ES versus control ICD patients without ES.     

Role of electrophysiologic study (EPS)-guided preventive therapy for the management of ventricular tachyarrhythmias in patients with heart failure.

BACKGROUND: Ventricular tachyarrhythmias (VT/VF) are 1 of the most important factors determining the prognosis of patients with heart failure (HF). Although priority is given to implantable cardioverter defibrillator (ICD) therapy for the prevention of sudden cardiac death, electrophysiologic-study (EPS)-guided preventive therapy could be important for reducing the number of cardiac events. METHODS AND RESULTS: Of 864 patients with a history of HF, an EPS was performed in 168 and 121 had inducible VT/VF. Under the basic therapy of an ICD, additional catheter ablation was attempted for 95 of 124 monomorphic VT foci in 74 patients, and 78 of the VT were successfully ablated. The prognoses were compared among 5 patient groups with different results for the EPS and catheter ablation: (1) success group (n=43), (2) failure group (n=15), (3) not attempted group (n=16), (4) VF group (n=47), and (5) no inducible VT/VF group. During a follow-up period of 31+/-22 months, the incidence of VT/VF was lower in the success and no inducible VT/VF groups than in the other groups (p=0.0018), although a significant difference was not observed for the total deaths. CONCLUSION: EPS-guided preventive therapy using an ICD and catheter ablation can be useful, at least for the reduction of arrhythmic events in patients with HF.     

Outcome in patients with an ICD incorporating cardiac resynchronisation therapy: differences between primary and secondary prophylaxis

BACKGROUND: The incidence of ventricular tachyarrhythmias in ICD patients with cardiac resynchronisation therapy (CRT-D) is not well studied. AIM: To analyse event free survival in CRT-D patients with a primary or a secondary prophylactic ICD indication. METHODS: Prospective, single centre. Eighty-six patients, 44% with a primary prophylactic indication. Actuarial event-free rates for mortality and arrhythmias were calculated. RESULTS: Baseline clinical characteristics were not significantly different between primary and secondary prophylaxis. Primary prophylaxis patients were more likely to be in NYHA class III. Over 21 months, 724 ventricular events with therapy occurred in 36 patients (42%). The actuarial event-free rates, at 1 and 3 years, from appropriate ICD therapy were higher (P<0.001) for primary (79.0% and 67.8%) than for secondary prophylaxis (45.6% and 27.0%). Appropriate ICD therapy occurred more in NYHA class II compared to class III (P=0.016). Underlying disease (ischemic versus non-ischemic) and functional class did not play a role in multivariate analysis. CONCLUSION: Important arrhythmic events in patients with heart failure, and CRT-D occur at a very high rate when the indication is secondary prophylaxis. Patients with primary prophylaxis have an annual event rate of 10%, even though they tend to have a worse heart failure class.     

无痛治疗在植入型心律转复除颤器患者心脏性猝死一级和二级预防中的应用

目的 随访植入型心律转复除颤器(ICD)患者,了解抗心动过速起搏(antitachycardia pacing,ATP)作为室性心动过速(VT)无痛治疗手段在心脏性猝死一级和二级预防中的应用.方法 对2005年1月至2009年6月符合ICD一级和二级预防标准并在我院植入ICD的患者进行随访.将ICD的诊断程序设置为VT...     

Long-term follow-up of sudden cardiac arrest survivors and electrophysiologically guided antiarrhythmic therapy

Sudden cardiac arrest survivors have a high risk of suffering from recurrent arrhythmic events. Recent studies have shown that these patients have a significantly decreased mortality rate, if they are supplied with an implantable cardioverter/defibrillator (ICD). The aim of this study was to evaluate the long-term prognosis of patients with electrophysiologically guided antiarrhythmic drug therapy in comparison to patients with ICD. 204 consecutive survivors of sudden cardiac arrest were enrolled in this study. All patients were examined with an initial electrophysiologic study (EPS) with programmed ventricular stimulation. Patients were treated with antiarrhythmic drugs (if the inducible tachycardia was suppressed) or with the implantation of an ICD. The maximal follow-up period was 120 months, the mean period was 53.3 +/- 31.4 months (ICD) versus 60.3 +/- 35.5 months (EPS, nonsignificant). Patients with ICD showed an overall mortality rate of 14.6%, whereas EPS-guided patients had a mortality rate of 43.2% (p < 0.001). The cardiac and arrhythmogenic mortality rates were significantly lower in the ICD group (12 vs. 43%, p < 0.01, and 1 vs. 16%, p < 0.001, respectively). A reduction of the mortality risk was observed in the ICD group by up to 61% (all-cause mortality), 52% (cardiac mortality) and 97.2% (arrhythmogenic mortality). In arrhythmic event survivors with ICD, arrhythmic and overall mortality rates are significantly lower compared to patients with an EPS-guided drug therapy. In the secondary prevention of sudden cardiac death, ICD should be the first choice of antiarrhythmic therapy.     

Improved survival of cardiac transplantation candidates with implantable cardioverter defibrillator therapy: role of beta-blocker or amiodarone treatment

INTRODUCTION: Survival in patients awaiting cardiac transplantation is poor due to the severity of left ventricular dysfunction and the susceptibility to ventricular arrhythmia. The potential role of implantable cardioverter defibrillators (ICDs) in this group of patients has been the subject of increasing interest. The aims of this study were to ascertain whether ICDs improve the survival rate of patients on the waiting list for cardiac transplantation and whether any improvement is independent of concomitant beta-blocker or amiodarone therapy. METHODS AND RESULTS: Data comprised findings from 310 consecutive patients at a single center who were evaluated and deemed suitable for cardiac transplantation and placed on the waiting list. Kaplan-Meier actuarial approach was used for survival analysis. Survival analysis censored patients at time of transplantation or death. Of the 310 patients, 111 (35.8%) underwent successful cardiac transplantation and 164 (52.9%) died while waiting; 35 patients remain on the waiting list. Fifty-nine (19%) patients had ICD placement for ventricular arrhythmias prior to or after being listed. Twenty-nine (49.1%) ICD patients survived until cardiac transplantation, 13 (22%) patients died, and 17 (28.8%) remain on the waiting list. Among non-ICD patients, 82 (32.7%) received transplants, 151 (60.2%) died, and 18 (7.2%) remain on the waiting list. Survival rates at 6 months and 1, 2, 3, and 4 years were better for all ICD patients compared to non-ICD patients (log-rank x2, P = 0.0001). By multivariate analysis, ICD therapy and beta-blocker treatment were the strongest predictors of survival. Further, ICD treatment was associated with improved survival independent of concomitant treatment with beta-blocker or amiodarone. Among ICD and non-ICD patients treated with a beta-blocker or amiodarone, survivals at the 1 and 4 years were 93% vs 69% and 57% vs 32%, respectively (log-rank x2, P = 0.003). CONCLUSION: ICD therapy is associated with improved survival in high-risk cardiac transplant candidates, and ICD benefit appears to be independent of concomitant treatment.