title: Implantable defibrillator therapy for ventricular tachyarrhythmia in left ventricular assist device patients.
abstract: OBJECTIVE
  Ventricular arrhythmias (VA) occur frequently after permanent left ventricular assist device (LVAD) implantation in end stage heart failure. Left ventricular assist device patients require rhythm control in contrast to patients with biventricular support. However, the rationale for implantable cardioverter-defibrillator (ICD) utilization in LVAD patients remains unclear. This study investigated the safety and efficacy of primary prevention ICD therapy and the rate of appropriate ICD interventions in LVAD patients.
  
  
  RESULTS
  We prospectively collected data from patients receiving LVADs. Patients without previous ICD received an ICD after LVAD implantation for primary prevention. Sixty-one patients with LVAD and ICD were followed prospectively for 365 +/- 321 days. Nine patients died from thromboembolism or haemorrhage. Overall, the rate of appropriate ICD interventions was 34%, mostly for treatment of monomorphic VT in 52%, polymorphic VT in 13%, and VF in 35%. Seventy-one percent of VA were terminated by overdrive pacing, 29% by shock. Patients with a history of VA before LVAD implantation had a significantly higher 1-year rate for ICD therapy compared with LVAD patients with a primary prevention ICD indication LVAD patients (50 vs. 24%). Similarly, patients with non-ischaemic cardiomyopathy had a significantly higher risk for ICD therapy than patients with ischaemic heart disease (50 vs. 22%).
  
  
  CONCLUSIONS
  Implantable cardioverter-defibrillator therapy is safe and effective in LVAD patients. Ventricular arrhythmias leading to ICD intervention occur frequently in 34% of LVAD patients after 1 year, with large variations depending on the underlying cardiac disease and previous arrhythmia history. Primary prevention ICD indication after LVAD implantation yields high rates of ICD intervention. A history of previous VA strongly predicts future use of ICD treatment after LVAD implantation.
authors.affiliation: Department of Cardiovascular Medicine, Hannover Medical School, Carl-Neuberg-Street 1, Hannover 30625, Germany. hanno_oswald@gmx.de
authors.forename: Hanno
authors.initials: H
authors.lastname: Oswald
authors.forename: Claudia
authors.initials: C
authors.lastname: Schultz-Wildelau
authors.forename: Ajmal
authors.initials: A
authors.lastname: Gardiwal
authors.forename: Ulrich
authors.initials: U
authors.lastname: Lüsebrink
authors.forename: Thorben
authors.initials: T
authors.lastname: König
authors.forename: Anna
authors.initials: A
authors.lastname: Meyer
authors.forename: David
authors.initials: D
authors.lastname: Duncker
authors.forename: Maximilian A
authors.initials: MA
authors.lastname: Pichlmaier
authors.forename: Gunnar
authors.initials: G
authors.lastname: Klein
authors.forename: Martin
authors.initials: M
authors.lastname: Strüber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D055815:Young Adult