IntroductionMost patients undergoing left ventricular assist

device (LVAD) implantation for destination therapy (DT) also have an implantable cardioverter defibrillator (ICD). Ventricular arrhythmias (VAs) are of unclear clinical significance in patients with LVADs; as such the exact role for ICDs in patients with LVADs has yet to be determined.

The purpose of our study was to determine the incidence of VAs requiring ICD therapies (anti-tachycardia pacing (ATP) and/or defibrillator shock) after LVAD implantation.

Materials and MethodsRetrospective chart review was performed in 62 patients

(84% male, 53% ischemic etiology, 19% mean ejection fraction) who underwent LVAD implant for DT from 2005 to 2008. ICDs were present in 52/62 (84%) patients pre-LVAD. Patients with simultaneous LVAD and ICD support were evaluated for significant VA occurrence. Significant VAs were defined as any ventricular tachycardia (VT) or ventricular fibrillation (VF) episodes requiring ICD therapy (ATP or shock) as confirmed by device interrogation reports.

Conclusions and Recommendations

A number of conclusions are suggested by the results of our study.

ICD therapy can be safely used in combination with LVADs. In our entire series, despite the fact that the majority of LVAD patients had ICDs present at the time of LVAD implantation, we did not have a single episode of ICD or LVAD malfunction resulting from the interaction between the two devices. Furthermore, in the patients that had VAs requiring ICD therapy, the LVAD did not interfere with proper ICD function.

Despite LVAD therapy, a significant number of patients in our series did experience VAs (16%) and were successfully treated by their ICDs.

The majority of ICD therapies occurred either very early or late post-LVAD implantation. 47% of total VAs occurred at <1 month, and 35% of total VAs occurred at >6 months after LVAD.

Overall, further studies with larger numbers of patients done in a prospective fashion are necessary to determine if ICDs should be implanted as standard of care in LVAD candidates prior to discharge, however at this time it would appear that ICDs can safely and feasibly be used in LVAD patients and that they do serve a purpose in treating VAs in these patients.

Ventricular Arrhythmias in Left Ventricular Assist Device Patients with Implantable Cardioverter Defibrillators

Erika Stahl, RN,BSN, Sunil Pauwaa, M.D., Sejal Modi, C.C.P., Pat Pappas, M.D., Antone Tatooles, M.D. and Geetha Bhat, Ph.D., M.D.The Center for Heart Transplant and Assist Devices,

Advocate Christ Medical Center, Oak Lawn, Illinois, United States, 60453.

Title: Ventricular Arrhythmias in Left Ventricular Assist Device Patients with Implantable Cardioverter Defibrillators

Erika Stahl, RN,BSN1, Sunil Pauwaa, M.D.1, Sejal Modi, C.C.P.1, Pat Pappas, M.D.1, Antone Tatooles, M.D.1 and Geetha Bhat, Ph.D., M.D.1. 1The Center for Heart Transplant and Assist Devices, Advocate Christ Medical Center, Oak Lawn, Illinois, United States, 60453.

Body: Introduction: Most patients undergoing left ventricular assist device (LVAD) implantation for destination therapy (DT) also have an implantable cardioverter defibrillator (ICD). The incidence of ventricular arrhythmias (VA) requiring ICD therapies in patients post-LVAD is not well described, nor is the role of ICDs post-LVAD.

Purpose: The purpose of our study was to determine the incidence of VAs requiring ICD therapies (anti-tachycardia pacing (ATP) and/or defibrillator shock) after LVAD implant.

Methods: Retrospective chart review was performed in 62 patients (84% male, 53% ischemic etiology, 19% mean ejection fraction) who underwent LVAD implant for DT from 2005 to 2008. ICDs were present in 52/62 (84%) patients pre-LVAD. Patients with simultaneous LVAD and ICD support were evaluated for significant VA occurrence. Significant VAs were defined as any ventricular tachycardia (VT) or ventricular fibrillation (VF) episodes requiring ICD therapy (ATP or shock) as confirmed by device interrogation reports.

Results:The mean duration of LVAD support at VA occurrence was 213 days (range 3-591). At discharge after LVAD, 69% were on amiodarone and 79% were on beta blockers.

ICD therapies were required in 9/52 (16%) patients for VAs (Table 1).

Conclusion: Our experience shows that 16% of LVAD patients have significant VA requiring ICD therapies despite left ventricular support. ICDs in post-LVAD patients appear to have a role in the treatment of these VA. Further studies are necessary to determine if ICDs should be implanted as standard of care in LVAD candidates prior to discharge.

Table 1. LVAD Patients Requiring ICD TherapyPatient (#) Type of VA Time Post-LVAD (days) ICD Therapy1 (HM XVE) VT 5 ATP

  VT 25 ATP/Shock  VT/VF 98 Shock x 8

2 (HMII) VT/VF 546 ATP/Shock  VT 567 ATP  VT 589 ATP/Shock  VT 591 ATP

VT/VF 643 Shock3 (HMII) VT/VF 48 Shock4 (HMII) VT 271 ATP

5 (HMII) VT 9 ATP/Shock x 6

6 (HMII) VF 265 Shock7 (HMII) VT/VF 461 ATP/Shock

8 (HM XVE) VT 118 ATP/Shock9 (HMII) VT 3 Shock x 2

  VT 5 Shock  VT 6 Shock

ResultsThe mean duration of LVAD support at VA

occurrence was 213 days. At discharge after LVAD, 69% were on amiodarone and 79% were on beta blockers.

ICD therapies were required in 9/52 (16%) patients for VAs (Table 1).

Table 1. LVAD Patients Requiring ICD TherapyPatient (#) Type of VA Time Post-LVAD (days) ICD Therapy

1 VT 5 Shock

  VT 11 ATP

  VT 25 ATP/Shock

  VT/VF 98 Shock x 8

2 VT/VF 546 ATP/Shock

  VT 567 ATP

  VT 589 ATP/Shock

  VT 591 ATP

3 VT/VF 48 Shock

4 VT 271 ATP

5 VT 9 ATP/Shock x 6

6 VF 265 Shock

7 VT/VF 461 ATP/Shock

8 VT 118 ATP/Shock

9 VT 3 Shock x 2

  VT 5 Shock

  VT 6 Shock

Table 2. Patient InformationVA (n=9) No VA (n=43)

Males 8/9 (88.90%) 36/43 (83.70%)Race

Caucasian 66.70% 53.50%African American 33.30% 37.20%

Average Age at time of first implant 54 years old 64.8 years oldNumber of years of HF prior to LVAD 88.9% > 1year 93.0% > 1 year

Type of LVAD at time of firing 7 HMII (77.8%) 2 HM XVE (22.2%) N/A

Pre-LVAD EF 17.30% 18.70%Etiology of HF

Ischemic 55.60% 48.80%Non-ischemic 44.40% 51.20%

History of Ventricular Arrhythmias (Prior to LVAD implant) 66.70% 67.40%Post-VAD medications

Amiodarone 77.80% 57.90%Beta-Blocker 88.90% 78.90%

Average time of follow up from LVAD implantation. 600.3 days 737.8 days