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DOI: 10.1055/s-0032-1332667
ICD in destination therapy after Jarvik 2000 LVAD implantation
Introduction: The use of ventricular assist devices for the ultimate treatment of refractory ventricular tachycardia has been described. After implantation of a left ventricular assist device (LVAD) destination therapy might be compromised by ventricular tachycardia. Here we report the successful combination of a Jarvik 2000 with an implantable cardioverter defibrillator (ICD).
Aims: Despite of optimal medical treatment a persistent cardiogenic shock after acute myocardial infarction made the implantation of a Jarvik 2000 in combination with CABG necessary. During ICU stay sustained ventricular tachycardia lead to hemodynamic instability and beginning right ventricular failure. To treat further episodes and prevent aggravation of RV dysfunction an ICD was implanted. The ICD discharged appropriately during LVAD support in order to terminate the episodes of sustained ventricular tachycardia without causing malfunction of the Jarvik 2000. The patient recovered afterwards and remained an asymptomatic outpatient in NYHA class II. Heart transplantation was performed 8 month later.
Discussion: Simultaneous implantation of an ICD in patients who received a Jarvik 2000 is possible and shows no interference between the two devices. When right ventricular failure develops due to repeated ventricular tachycardia the restoration of rhythm via an ICD essentially supports cardiac recovery.