Ann Thorac Surg 2003;76:1747
© 2003 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Advanced heart failure requiring three devices for survival
Boris Schmidt, MDa*,
Michael P. Siegenthaler, MDb,
Christoph Bode, MDa,
Friedhelm Beyersdorf, MDb,
Manfred Zehender, MDa
a department of Cardiology, University of Freiburg, Freiburg, Germany,
b department of Cardiovascular Surgery, University of Freiburg, Freiburg, Germany
* Address reprint requests to Dr Schmidt, Universitätsklinikum Freiburg, Abt Innere Medizin III, Hugstetterstr 55, D-79106 Freiburg, Germany.
e-mail: schmidtb{at}med1.ukl.uni-freiburg.de
A 61-year-old man with a history of dilative cardiomyopathy and prior cardiac arrest was admitted with recurrent episodes of ventricular tachycardia successfully treated by shock therapy from his implanted cardiac defibrillator ([ICD] Ventak Mini+, CPI Guidant [St. Paul, MN]). After admission the patient received a left ventricular assist device (Jarvik 2000) for progressive heart failure in May 2001 (Fig 1;
I = implanted cardiac defibrillator; J = Jarvik; R = Reveal). To prevent false-positive triggering of the ICD by the implanted Jarvik 2000, ICD inactivation was initially recommended. Owing to repetitive ventricular tachycardia, however, ICD therapy was required. To independently document potential interaction between the Jarvik 2000 and the ICD, an additional event recorder (Reveal Plus; Medtronic Minneapolis, MN) was implanted (Fig 1). During a 6-month follow-up recurrent episodes of ventricular tachycardia and ventricular fibrillation were detected and were successfully treated by the ICD (see electrocardiographic tracings of Reveal and ICD in Fig 2).
Because the assist device guaranteed circulatory flow the patient did not encounter hemodynamic compromise or syncope. There was no evidence of false-positive triggering of the ICD by the Jarvik 2000.
