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• W2325621544 abstract "Purpose: Left Ventricular Assist Device (LVAD) support is being increasingly used in end-stage heart failure patients. Most of LVAD recipients have an implantable cardioverter-defibrillator (ICD). However, little is known about clinical implications of the simultaneous use of LVAD and ICD in a same patient.Methods: All patients who underwent LVAD implantation with concomitant ICD therapy at our institution between June 2007 and August 2012 were included. All LVADs were continuous flow pumps (Thoratec Heart Mate II), implanted for refractory heart failure, as a bridge to transplantation or as destination therapy. Follow-up started from date of simultaneous use of both devices (LVAD and ICD) in a same patient, to end with death, heart transplantation, or on December 1st, 2012. We sought to investigate (1) electromagnetic interferences between LVAD and ICD telemetry, (2) impact of LVAD placement on right ventricular (RV) lead parameters, (3) ventricular arrhythmias (VA) occurrence post LVAD implantation.Results: The study population consisted of 23 patients (17 males, 73%), with a median age of 50 years [47-60]. Median LVEF was 15% [10-25]. All brands of ICDs were implanted. The median duration of LVAD support was 182 [48-478] days. In three patients, ICD implantation was performed after LVAD placement. Loss of ICD telemetry occurred after LVAD implantation in 4 patients (St Jude Medical Atlas V-193, V-240, V-243, and Sorin CRT 8750), requiring ICD replacement (n=2), metal shielding use (n=1), and change in the programmer head position (n=1). LVAD implantation was associated with a decrease in RV sensing threshold (9.0 mV [8.1-12.4] vs. 12.0 mV [8.0-15.9]; p=0.04), a decrease in RV impedance (456 ohms [407-549] vs. 520 ohms [483-592]; p<0.01), and a trend towards an increase in RV pacing threshold (0.95 V [0.74-1.03] vs. 0.75 V [0.5-1.0]; p=0.08), without clinical adverse consequences. Eleven patients (47.8%) experienced ventricular arrhythmias under LVAD therapy, mostly well tolerated. Seven of these 11 patients experienced electrical storms, and 8 received appropriate shocks. The single factor associated with the occurrence of VA in LVAD recipients was a history of VA before LVAD implantation (OR 25 [2.9-213]; p=0.003).Conclusion: Electromagnetic interferences between LVAD and ICD telemetry can require ICD replacement. LVAD placement is associated with significant changes in right ventricular lead parameters. Ventricular arrhythmias occur in half of LVAD patients, and their occurrence is strongly predicted by a history of ventricular arrhythmias before LVAD implantation." @default.
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• W2325621544 date "2013-08-02" @default.
• W2325621544 modified "2023-10-18" @default.
• W2325621544 title "Clinical implications of left ventricular assist device implantation in implantable cardioverter-defibrillator patients" @default.
• W2325621544 doi "https://doi.org/10.1093/eurheartj/eht308.p2184" @default.
• W2325621544 hasPublicationYear "2013" @default.
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