Preliminary results with the simultaneous use of implantable cardioverter defibrillators and permanent biventricular pacemakers: Implications for device interaction and development

We report our preliminary experience with the combined use of implantable c ardioverter defibrillators (ICD) and biventricular pacemakers in six patien ts with heart failure and malignant ventricular arrhythmia. Two patients un derwent ICD implantation for malignant ventricular arrhythmia after previou s biventricular pacemaker implantation. One patient underwent biventricular pacemaker insertion for NYHA Class III heart failure after previous ICD im plantation. Two patients underwent single device implantation. In the sixth patient, a combined implantation failed due to an inability to obtain a sa tisfactory left ventricular pacemaker lead position. The potential for devi ce interaction was explored during implantation. In two patients a potentia lly serious interaction was discovered. Subsequent alterations in device co nfiguration and programming prevented these interactions with long-term use . No complication of combined device use has been demonstrated during a mea n follow-up of 2 months (range 1-4 months). Satisfactory ICD and pacemaker function has also been demonstrated. We conclude that combined device impla ntation may be feasible with currently available pacing technology and that further prospective studies are required in this area.