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.