Last Updated: 2010-01-27 17:37:32 -0400 (Reuters Health)
NEW YORK (Reuters Health) - In patients with severe congestive heart failure, simultaneous use of a left ventricular assist device (LVAD) and an implantable cardioverter-defibrillator (ICD) is not contraindicated.
Using the two together to treat pump failure and prevent sudden cardiac death "is clinically feasible and...no relevant interactions occur," lead author Dr. Michael Kuhne confirmed in an email message to Reuters Health.
In a December 23rd online paper in the American Journal of Cardiology, Dr. Kuhne and colleagues from the University of Michigan Health System in Ann Arbor report on 76 patients with class IV heart failure who were using both devices.
Most had received the ICD well before the LVAD (with a median of 591 days between ICD and LVAD placement).
During a median follow-up of 156 days (with an interquartile range of 71 to 292), 12 patients received 54 ICD therapies, of which 80% were appropriate. None of the inappropriate therapies involved device interactions.
Twenty-two patients (29%) had ventricular arrhythmias requiring cardioversion or defibrillation.
Overall, 55 patients (72%) received heart transplants at a median of 146 days after LVAD implantation, 12 (16%) died during simultaneous LVAD and ICD therapy, and 9 (12%) were still using both devices when the authors were writing the paper.
The 12 deaths were not from circulatory causes; rather, the LVAD was turned off "for medical reasons unrelated to pump failure, ventricular arrhythmia, or mechanical problems."
Interactions between the LVAD and ICD occurred in only 2 patients. They were using HeartMate II pumps and older St. Jude Medical ICDs. The pulse width modulator of the HeartMate II LVAD operates at a similar frequency to the ICD telemetry operating frequency, according to the authors.
In both patients, the interaction was quickly identified and fixed, with no adverse effects. Overall, the investigators say, device interactions are unusual and appear limited to specific models of ICDs.
Dr. Kuhne pointed out: "For patients with the most advanced stages of heart failure, this means that two potentially life-saving therapies can be combined safely."
Am J Cardiol 2009.
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