title: Clinical experience of combined HeartWare ventricular assist device and implantable cardioverter defibrillator therapy.
abstract: BACKGROUND
  The HeartWare continuous flow ventricular assist device (HVAD) is used in an increasing number of heart failure patients. In those patients, ventricular arrhythmias (VAs) are common and, consequently, many patients already have an implanted implantable cardioverter defibrillator (ICD) in place or receive ICD implantation after left ventricular assist device implantation. However, limited data on feasibility and necessity of combined ICD and HVAD therapy are available. In this study we present our technical and clinical experience.
  
  
  RESULTS
  Between 01/2010 and 06/2013, 41 patients received HVAD implantation. Twenty-six HVAD patients who already had an ICD device placed prior to HVAD implantation or received ICD implantation afterwards were enrolled in this study. Peri- and postoperative complications as well as ICD interrogations were documented and analyzed retrospectively. Mean patients age was 58.4 ± 12.6 years; 88.5% of patients were male. During mean follow-up of 12.2 ± 8.9 months, appropriate ICD interventions occurred in 9 patients (34.6%) due to ventricular tachyarrhythmia (n = 7) or ventricular fibrillation (n = 2). An inappropriate ICD intervention was seen in 1 patient (3.9%) due to tachycardic atrial fibrillation. Patients on HVAD with a history of VAs (n = 13) had a significantly higher incidence of ICD interventions compared to patients with primary prophylactic indication for ICD (n = 13; 53.8% vs. 7.7%; P = 0.015). No disturbance of ICD function was seen after HVAD implantation.
  
  
  CONCLUSIONS
  Combined ICD and HVAD therapy was safe and feasible, without electromagnetic interference between ICD and ventricular assist device. The incidence of ICD interventions was high in patients with a history of VAs, but low in patients with ICD implantation for primary prevention.
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center, Hamburg, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Pecha
authors.forename: Iris
authors.initials: I
authors.lastname: Wilke
authors.forename: Alexander
authors.initials: A
authors.lastname: Bernhardt
authors.forename: Samer
authors.initials: S
authors.lastname: Hakmi
authors.forename: Yalin
authors.initials: Y
authors.lastname: Yildirim
authors.forename: Daniel
authors.initials: D
authors.lastname: Steven
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
authors.forename: Tobias
authors.initials: T
authors.lastname: Deuse
authors.forename: Ali
authors.initials: A
authors.lastname: Aydin
mesh_terms: D003131:Combined Modality Therapy / Q000295:instrumentation / Q000379:methods; D017147:Defibrillators, Implantable; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000517:prevention & control*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
keywords: implantable cardioverter defibrillator; left ventricular assist device; ventricular arrhythmias; ventricular tachycardia