Implantable cardioverter-defibrillator shocks in patients with a left ventricular assist device

Ambardekar, Amrut V.; Allen, Larry A.; Lindenfeld, JoAnn; Lowery, Christopher M.; Cannon, Anne; Cleveland, Joseph C.; Brieke, Andreas; Sauer, William H.

doi:10.1016/j.healun.2010.02.001

Cited by 68 publications

(47 citation statements)

References 12 publications

(19 reference statements)

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“…6 Similar findings have been seen in single-center observational studies, where VA have been reported to occur in 22% to 59% of LVAD recipients (Table). 6,[10][11][12][13][14][15][16][17][18] Incident VAs are also seen in patients who have not had VA before LVAD implant. Ziv et al 14 retrospectively studied 91 consecutive patients who underwent implant of a firstgeneration Heartmate XVE device.…”

Section: Epidemiologymentioning

confidence: 99%

Ventricular Arrhythmias After Left Ventricular Assist Device

Nakahara

Chien

Gelow

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Section: Epidemiologymentioning

confidence: 99%

Ventricular Arrhythmias After Left Ventricular Assist Device

Nakahara

Chien

Gelow

et al. 2013

Circ: Arrhythmia and Electrophysiology

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“…However, all the devices from the standpoint of appropriate therapies seem to function well. 21 In our center, we have established a protocol for patients with an LVAD to examine for EMI risk, and if present, to minimize the risk of inappropriate therapies (Figure 3). In all patients, the ICD, regardless of manufacturer or lead placement, will be studied for EMI with the LVAD at maximum output.…”

Section: Discussionmentioning

confidence: 99%

Electromagnetic Interference of Automatic Implantable Cardioverter Defibrillator and HeartWare Left Ventricular Assist Device

et al. 2013

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The use of continuous-flow left ventricular assist devices (LVAD) have markedly improved outcomes in patients with advanced heart failure (HF). The HeartWare LVAD is a miniaturized centrifugal pump implanted within the pericardial space. Implantable cardioverter-defibrillators (ICDs) are susceptible to oversensing of extracardiac signals (electromagnetic interference [EMI]). We report two cases of EMI in patients that received a HeartWare LVAD as destination therapy for advanced HF. The patients were 75 and 78 years old, both with severe ischemic dilated cardiomyopathy (ejection fraction < 0.20) and New York Heart Association class 4 heart failure. Both patients had a St. Jude Medical Unify ICD with a 7 Fr dual coil St. Jude Medical Durata ICD lead. In both patients, the lead location was in the right ventricular apex with an inferior orientation. Both patients experienced immediate ICD therapies after LVAD placement, requiring the tachytherapies to be disabled. ICD programming changes to increase sensitivity and the detection windows were ineffective. Both patients underwent ICD system revision. In one patient, the existing lead was moved to an anteroseptal location that stopped the EMI. In the other patient, the ICD system was changed to allow a separate right ventricular sensing lead in an anteroseptal location and a dual coil ICD lead placed in an apical location, a strategy used to obtain an acceptable defibrillation threshold. The patients have had no subsequent EMI detected on clinical and remote monitoring. Patients with a right ventricular apical ICD lead placement that undergo placement of a HeartWare LVAD are susceptible to EMI and inappropriate ICD therapies. These cases suggest the primary mechanism is proximity of the ICD lead to the device and as such relocation to an anteroseptal location can overcome the problem. These data suggest that all patients that receive a HeartWare LVAD with an ICD should have the device carefully checked at maximum LVAD output to determine if EMI may be present. ASAIO Journal 2013;59:136-139. Key Words: left ventricular assist device, electromagnetic interference, improper ICD shocks, end-stage heart failure.

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“…10 However, frequent ICD shocks in heart failure patients have been shown to have a negative impact on longterm outcome, 11 and this appears to be the case even where pump failure is effectively treated by a LVAD. 12 It needs to be understood that the role of an ICD in the LVAD-supported patient is no longer to prevent sudden cardiac death, but rather to terminate ventricular arrhythmia which may lead to decompensation in clinical status. Our recent findings that outcomes in patients with ICD therapies active or inactive are similar post-LVAD implant 13 underline that this is an issue that continues to require ongoing study and streamlining of the appropriate use of ICD technology in these patients.…”

Section: Discussionmentioning

confidence: 99%

Ventricular Fibrillation in an Ambulatory Patient Supported by a Left Ventricular Assist Device

Boilson

Durham

2012

ASAIO Journal

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Left ventricular assist devices (LVADs) provide an effective means of managing advanced pump failure as a means of bridging to cardiac transplantation or as permanent therapy. Although ventricular arrhythmias remain common post-LVAD implantation, such therapy may allow malignant arrhythmias to be tolerated hemodynamically. This report describes the clinical findings in a patient who had likely been in a ventricular tachyarrhythmia for several days and presented in ventricular fibrillation, ambulatory, and mentating normally. This report, with previous similar reports, is additive to the body of evidence that LVADs alter the physiologic impact of ventricular arrhythmias in advanced heart failure and highlights the need for thoughtful programming of implantable cardioverter defibrillator therapies in these patients.

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Implantable cardioverter-defibrillator shocks in patients with a left ventricular assist device

Cited by 68 publications

References 12 publications

Ventricular Arrhythmias After Left Ventricular Assist Device

Ventricular Arrhythmias After Left Ventricular Assist Device

Electromagnetic Interference of Automatic Implantable Cardioverter Defibrillator and HeartWare Left Ventricular Assist Device

Ventricular Fibrillation in an Ambulatory Patient Supported by a Left Ventricular Assist Device

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