title: Simultaneous use of implantable cardioverter-defibrillators and left ventricular assist devices in patients with severe heart failure.
abstract: More patients who are receiving therapy with a left ventricular assist device (LVAD) also have an implantable cardioverter-defibrillator (ICD). The aim of the present study was to describe the outcomes and device interactions of simultaneous therapy with an ICD and a LVAD. We evaluated 76 patients with class IV heart failure (age 52 + or - 12 years, left ventricular ejection fraction 0.13 + or - 0.05%, 88% men, 61% nonischemic cardiomyopathy) with both an ICD and a LVAD. The median follow-up with both devices was 156 days. A LVAD with a pulsatile and continuous flow pump was used in 53 (70%) and 23 (30%) patients, respectively. Of the 76 patients, 12 (16%) received a total of 54 ICD therapies. Of the ICD therapies, 88% were appropriate. Of the 76 patients, 55 (72%) underwent heart transplantation a median of 146 days after LVAD implantation. Twelve patients (16%) died during simultaneous ICD and LVAD therapy. Interactions between the LVAD and ICD occurred in 2 patients (2.7%) with continuous flow pumps (HeartMate II). In both cases, telemetry failure occurred after LVAD implantation with 2 different models of ICDs from the same manufacturer. No ICD therapies occurred because of device-related interactions. In conclusion, simultaneous ICD and LVAD therapy in patients with severe congestive heart failure is safe and clinically feasible. Interactions between the devices are uncommon and appear limited to specific models of ICDs.
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA. kuehnem@uhbs.ch
authors.forename: Michael
authors.initials: M
authors.lastname: Kühne
authors.forename: Michaela
authors.initials: M
authors.lastname: Sakumura
authors.forename: Stephen Scott
authors.initials: SS
authors.lastname: Reich
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Sarrazin
authors.forename: Darryl
authors.initials: D
authors.lastname: Wells
authors.forename: Nagib
authors.initials: N
authors.lastname: Chalfoun
authors.forename: Thomas
authors.initials: T
authors.lastname: Crawford
authors.forename: Warangkna
authors.initials: W
authors.lastname: Boonyapisit
authors.forename: Laura
authors.initials: L
authors.lastname: Horwood
authors.forename: Aman
authors.initials: A
authors.lastname: Chugh
authors.forename: Eric
authors.initials: E
authors.lastname: Good
authors.forename: Krit
authors.initials: K
authors.lastname: Jongnarangsin
authors.forename: Frank
authors.initials: F
authors.lastname: Bogun
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
authors.forename: Francis
authors.initials: F
authors.lastname: Pagani
authors.forename: Frank
authors.initials: F
authors.lastname: Pelosi
mesh_terms: D000328:Adult; D017147:Defibrillators, Implantable / Q000009:adverse effects; D004867:Equipment Design; D004868:Equipment Failure; D019544:Equipment Failure Analysis; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis