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.