Cardioverter-Defibrillator Implantation to Safeguard Against Fa- tal Arrhythmias in Cardiomyoplasty Patients

A potentially low-risk surgery to improve hemodynamics and functional class in heart failure patients and others with advanced ventricular dysfunction, dynamic cardiomyoplasty (CMP) has been performed over 1,000 times worldwide. During long-term follow-up, arrhythmic sudden cardiac death remains a major cause of death with any advanced medical management (i.e., a 15%−50% risk of recurrent cardiac arrest despite drug suppression of inducible arrhythmia, including amiodarone). Combining our research expertise and clinical capabilities in electrophysiology with the technological expertise of Medtronic, Inc., a newly devised protocol for combined cardioverter-defibrillator implantation (ICD) and CMP was created from Medtronic protocols for cardiomyoplasty, ICD implantation, and prevention of “cross-talk” (i.e., adverse interaction due to over-sensing signals emitted by another implanted device). In this largest published series of patients who have undergone CMP with concomitant ICD implantation (5 patients at the Milwaukee Heart Institute), we describe measures to prevent cross-talk and categorize cases according to timing of ICD implantation: 1) soon after CMP, 2) several months after CMP (in patients who develop ventricular tachycardia), or 3) considerably before CMP. We have not yet experienced a fourth scenario, i.e., simultaneous ICD implantation and CMP; however, we believe that we have established the groundwork for this eventuality.