Background
There are limited data on the performance of the subcutaneous implantable cardioverter-defibrillator
(S-ICD) in patients with a left ventricular assist device (LVAD).
Objective
The purpose of this study was to describe the clinical course and outcomes of patients
with both an S-ICD and an LVAD at our institution and via a systematic review of published
studies.
Methods
We performed a retrospective cohort study of all patients who underwent LVAD implantation
from 2009 to 2019 at Duke University Hospital. We also performed a systematic review
of studies involving patients with an S-ICD and LVAD using the PubMed/Embase databases.
Results
Of 588 patients undergoing LVAD implantation with a preexisting implantable cardioverter-defibrillator,
4 had an S-ICD in situ after LVAD implantation. All 4 patients developed electromagnetic
interference (EMI) in the primary/secondary vectors after LVAD implantation, resulting
in inappropriate implantable cardioverter-defibrillator shocks in 2 patients. Sensing
in the alternate vector was adequate immediately postoperatively in 1 patient. Postoperative
undersensing was present in the alternate vector in 3 patients but improved at first
outpatient follow-up in 2 patients, allowing tachy therapies to be reenabled. Eight
studies involving 27 patients were identified in the systematic review. EMI was common
and frequently absent in the alternate vector (6 of 7 patients).
Conclusion
Undersensing and EMI are common after LVAD implantation in patients with an S-ICD
in situ, particularly in the primary and secondary sensing vectors. Undersensing in
the alternate vector may improve during follow-up, obviating the need for device revision
or extraction.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart RhythmAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cardiac implantable electronic devices in patients with left ventricular assist systems.J Am Coll Cardiol. 2018; 71: 1483-1493
- Multicenter experience of concomitant use of left ventricular assist devices and subcutaneous implantable cardioverter-defibrillators.JACC Clin Electrophysiol. 2018; 4: 1261-1262
- Electrocardiographic changes after implantation of a left ventricular assist device—potential implications for subcutaneous defibrillator therapy.J Electrocardiol. 2019; 52: 29-34
- ICD lead parameters, performance, and adverse events following continuous-flow LVAD implantation.Pacing Clin Electrophysiol. 2014; 37: 464-472
- Prospective evaluation of implantable cardioverter-defibrillator lead function during and after left ventricular assist device implantation.JACC Clin Electrophysiol. 2016; 2: 343-354
- Prospective blinded evaluation of a novel sensing methodology designed to reduce inappropriate shocks by the subcutaneous implantable cardioverter-defibrillator.Heart Rhythm. 2018; 15: 1515-1522
- Subcutaneous implantable cardioverter defibrillators in patients with left ventricular assist devices: case report and comprehensive review.Eur Heart J Case Rep. 2019; 3: 5-7
- Subcutaneous implantable cardioverter-defibrillator shocks after left ventricular assist device implantation.Circ Arrhythm Electrophysiol. 2016; 9: 1-3
- Subcutaneous implantable cardioverter defibrillator (S-ICD) shocks in a patient with a left ventricular assist device.Pacing Clin Electrophysiol. 2018; 41: 309-311
- Troubleshooting electromagnetic interference in a patient with centrifugal flow left ventricular assist device and subcutaneous implantable cardioverter defibrillator.J Cardiovasc Electrophysiol. 2018; 29: 477-481
- Left ventricular assist device in a patient with a concomitant subcutaneous implantable cardioverter defibrillator.Circ Arrhythm Electrophysiol. 2013; 6: e32-e33
- Subcutaneous implantable cardioverter-defibrillator implantation in a patient with a left ventricular assist device already in place.Tex Heart Inst J. 2015; 42: 140-143
- No electromagnetic interference occurred in a patient with a HeartMate II left ventricular assist system and a subcutaneous implantable cardioverter-defibrillator.Tex Heart Inst J. 2016; 43: 183-185
Article info
Publication history
Published online: April 15, 2020
Footnotes
Drs Black-Maier and Barnett have received educational support from Boston Scientific. Dr Lewis serves as a consultant to Philips, Medtronic, and Boston Scientific. Dr Piccini receives grants for clinical research from Abbott, the American Heart Association, the Association for the Advancement of Medical Instrumentation, Bayer, Boston Scientific, the National Heart, Lung, and Blood Institute, and Philips and serves as a consultant to Abbott, Allergan, ARCA Biopharma, Biotronik, Boston Scientific, LivaNova, Medtronic, Milestone, Myokardia, Sanofi, Philips, and UptoDate. Dr Pokorney has received research grants from Boston Scientific, Janssen Pharmaceuticals, Bristol-Myers Squibb, Pfizer, and Gilead and consulting support from Boston Scientific, Medtronic, Bristol-Myers Squibb, Pfizer, Janssen Pharmaceuticals, and Zoll. The rest of the authors report no conflicts of interest.
Identification
Copyright
© 2020 Heart Rhythm Society. All rights reserved.
