Left Ventricular Mechanical Assist Devices and Cardiac Device Interactions: An Observational Case Series

Foo, David; Walker, Bruce D.; Kuchar, Dennis L.; Thorburn, Charles W.; Tay, Andre; Hayward, Christopher; Macdonald, Peter S.; Keogh, Anne; Kotlyar, Eugene; Spratt, P.; Jansz, P.

doi:10.1111/j.1540-8159.2009.02403.x

Cited by 53 publications

(47 citation statements)

References 19 publications

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“…In addition, ventricular arrhythmias can cause lower LVAD flows, predispose patients to development of LV thrombus formation, and result in hemodynamic compromise in some patients. 7,10 In this study, we found that almost 25% of patients received an appropriate ICD shock for a ventricular arrhythmia, which provides some evidence that the use of ICDs in patients with LVADs may be justified. Potential predictors for receiving ICD shocks that were found in this study included male gender, non-Caucasian race and LVAD placement as destination therapy.…”

Section: Discussionmentioning

confidence: 85%

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

Ambardekar

Allen

Lindenfeld

et al. 2010

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 85%

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

Ambardekar

Allen

Lindenfeld

et al. 2010

The Journal of Heart and Lung Transplantation

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“…Two studies reported that after LVAD implant, right ventricular ICD leads have a decrease in R-wave amplitude, a decrease in impedance, and an increase in capture threshold even among leads that with previous, chronically stable characteristics. 38,39 This can result in various ICD problems, including failure to sense VAs, failure to capture, and inappropriate pacing caused by undersensing. We have also observed interference that likely resulted from interaction of a very apically placed chronic right ventricular defibrillator lead with the inflow cannula apparatus (Figure 3).…”

Section: Icd Therapymentioning

confidence: 99%

Ventricular Arrhythmias After Left Ventricular Assist Device

Nakahara

Chien

Gelow

et al. 2013

Circ: Arrhythmia and Electrophysiology

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“…R-wave amplitude often decreases after VAD implant, possibly because of left ventricular core removal for cannula insertion and remodeling. 63,64 Thus, the ICD operates at a more sensitive setting, increasing the risk of oversensing all extracardiac signals. Because the power line or motor is often in close proximity to the sensing bipole near the RV apex, VAD EMI often has greater amplitude on the sensing channel [65][66][67] than the shock channel.…”

Section: Medical Sourcesmentioning

confidence: 99%

Troubleshooting Implanted Cardioverter Defibrillator Sensing Problems I

Swerdlow

Asirvatham

Ellenbogen

et al. 2014

Circ: Arrhythmia and Electrophysiology

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electrograms from floating bipolar atrial electrodes on defibrillation leads. 12,13 The former requires a dual-coil lead and the latter a specialized lead. Evaluating Sensing From ICD ElectrogramsFilter settings may influence electrogram appearance (Figure 2). Wideband signals with minimal filtering reproduce QRS complexes accurately and retain the distinctive, rounded appearance of T waves. Highly filtered narrowband signals display the signal that is compared with the sensing threshold in the sensing process, but they alter signal amplitude and polarity, markedly reducing the amplitude of signals with prominent low-frequency components, such as T waves and some components of VF ( Figure I in the Data Supplement). Programmable filter settings (St. Jude Medical and Biotronik) permit assessing the effect of filtering on R-and T-wave amplitude.Sampling is the process of converting an analog signal into a digital sequence. It must be performed at ≥2× the source's signal frequency to reproduce the source's information content completely. ICD telemetry reproduces cardiac signals completely because it samples at 128 to 256 Hz per channel, but it may distort nonphysiological signals periodically (Figure II in the Data Supplement) 14 and it may not completely reproduce myopotentials that have frequency content >100 Hz. Stored Versus Real-Time ElectrogramsStored electrograms and their corresponding interval and episode data are the primary sources for diagnosing devicedetected tachycardias. Real-time electrograms are useful in troubleshooting reproducible oversensing: lead or connector problems in the pocket may be identified by pocket manipulation, pectoral or diaphragmatic myopotentials can be provoked by pectoral muscle contraction and straining or deep breathing, respectively (Figure III in the Data Supplement). Differential electrograms recorded simultaneously between 1 common electrode and 2 different electrodes are useful when lead or connector-related oversensing is suspected (Figure 3). Role of Additional Diagnostics, Alerts, and Remote MonitoringTrend plots of P-and R-wave amplitude, impedance measurements and trends, and algorithms that identify oversensing facilitate electrogram interpretation as discussed below. Alerts for suspected oversensing may notify the patient using audible tones or pulse generator vibration, may be transmitted via internet-based remote-monitoring networks, or both. Remote monitoring has transformed follow-up of sensing problems, permitting rapid determination of cause of an alert and implementation of a response plan, especially for devices with wireless telemetry.16,17 Troubleshooting Ventricular OversensingPresentation, Classification, and Recognition Clinical PresentationIn ICD patients, ventricular oversensing of rapid signals presents as oversensing alerts or inappropriate detection of VT/ VF, often resulting in inappropriate shocks. In pacemakerdependent patients it also presents as failure to deliver bradycardia pacing. ClassificationOversensing can be classified by electro...

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Left Ventricular Mechanical Assist Devices and Cardiac Device Interactions: An Observational Case Series

Abstract: LVADs have a definite impact on cardiac devices in respect with alteration of lead parameters, ventricular tachyarrhythmias, and electromagnetic interference.

Cited by 53 publications

References 19 publications

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

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

Ventricular Arrhythmias After Left Ventricular Assist Device

Troubleshooting Implanted Cardioverter Defibrillator Sensing Problems I

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