The Role of Biventricular Implantable Defibrillator in Heart Transplant Recipients

Background: Sudden cardiac death and heart failure are common complications following orthotopic heart transplantation. The role of biventricular implantable cardioverter-defibrillators (BiV ICDs) in this population is unknown with minimal available data. Objective: Highlight the safety and utility of BiV ICD placement among orthotopic heart transplant recipients. Case: A 69-year-old male with a medical history notable for type II diabetes, and prior non-ischemic cardiomyopathy requiring BiV ICD and after that, he needed left ventricular assist device (LVAD) placement and ultimately heart transplantation and explantation of his prior BiV ICD. He developed ischemic cardiomyopathy. Cardiac MRI revealed left ventricular dilation, thinning and dyskinesis in the distribution of the left anterior descending (LAD coronary artery and a reduced ejection fraction of 25%. Cardiac catheterization demonstrated 100% occlusion of the middle left anterior descending coronary artery with distal collateralization. ECG demonstrated RBBB with QRS duration of 157 milliseconds. We proceeded with new BiV ICD on the right side due to vein occlusion on the left side. On 24-month follow up, the patient is doing well with no heart failure admission and no ICD therapy. Conclusions: BiV ICD placement might be a safe and viable option among orthotopic cardiac transplant recipients to manage heart failure and prevent sudden cardiac death.