Combining nonpharmacologic therapies for advanced heart failure: The Munster experience with the assist device-defibrillator combination

Implantable cardioverter defibrillators (ICDs) and ventricular assist devic es (VADs) have been used as a bridge to cardiac transplantation. in selecte d patients, the combined implantation may be required. This study was motiv ated by a case of a 33-year-old female patient with giant cell myocarditis who died of ventricular tachyarrhythmias after having been placed on a VAD with which she had been treated on an out-of-hospital basis for a prolonged period of time. A subsequent retrospective analysis of our data showed tha t, of 73 patients who had to be bridged mechanically (54 Novacor, 12 TCI He artmate, 4 Thoratec, 3 Medos) in our institution between 1993 and 1998, 10 patients had undergone defibrillator implantation either before (n = 8) or after (n = 2) implantation of a VAD. The cases are presented, and the feasi bility of the combination therapy discussed. (C) 1999 by Excerpta Medico, I nc.