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DOI: 10.1055/s-0034-1367416
First clinical experience with combined HeartWare ventricular assist device and implantable cardioverter defibrillator therapy
Objectives: The Heartware continuous flow ventricular assist device (HVAD) is used in an increasing number of heart failure patients for bridge to recovery, bridge to transplant, or as destination therapy. In heart failure patients, ventricular arrhythmias are common and consequently many patients already have an implanted ICD in place or receive ICD implantation after LVAD implantation. However, little data on feasibility and necessity of combined ICD and HVAD therapy is available. In this study we present our technical and clinical experience in those patients.
Methods: 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 prospectively enrolled in this study. Phenprocoumon therapy was maintained during ICD implantation with INR levels between 2.0 and 2.5, avoiding potential bleeding complications of overlapping heparin bridging therapy. Peri- and postoperative complications as well as ICD interrogations were documented.
Results: Mean patients age was 58.4 ± 12.6 years, 88.5% of patients were male. Nine patients were implanted with a new single- (n = 6) or dual-chamber (n = 3) ICD. During ICD implantation, no major, but two minor complications occurred. During follow-up (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 one patient (3.9%) due to tachycardic atrial fibrillation, which did not re-appear after re-programming of the ICD device. During HVAD support, patients with a history of ventricular tachycardia had a significantly higher incidence of ICD interventions compared to patients with primary preventive indication for ICD (57.1% vs. 8.3% p = 0.015). New onset of VA after HVAD implantation was observed in one patient only, where VAs were mechanically triggered by impingement of the inflow cannula on the left ventricular (LV) myocardium after LV remodeling. No disturbance of ICD function was seen after HVAD implantation.
Conclusion: Combined ICD and HVAD therapy was safe and feasible, without disturbance of ICD function by the 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.