Electromagnetic interference from left ventricular assist device in patients with transvenous implantable cardioverter‐defibrillator

Abstract

Background Many advanced heart failure patients have both a left ventricular assist device (LVAD) and an implantable cardioverter‐defibrillator (ICD). This study examines incidence, clinical impact, and management of LVAD‐related EMI. Methods We performed a three‐center retrospective analysis of transvenous ICD implanted patients with LVAD implanted between January 1, 2005 and December 31, 2020. The primary outcome was EMI after LVAD implantation, categorized as LVAD‐related noise or telemetry interference. Results The rate of LVAD‐related EMI among the 737 patients (mean age 58.6 ± 12.8 years) studied was 5.0%. Telemetry interference (1.5%) compromised ICD interrogation in all patients. This was resolved successfully with use of a metal shield, encased wand, radiofrequency tower, different ICD programmer or by increasing distance between ICD programmer and LVAD (n = 6). ICD replacement was required to reestablish successful communication in three patients. LVAD‐related noise (3.5%) led to oversensing (n = 4), inappropriate mode switches (n = 4), noise reversion (n = 3), inhibition of pacing (n = 2), inappropriate detection as atrial fibrillation (AF) (n = 2) and inappropriate detection as ventricular tachycardia (VT) and/or ventricular fibrillation (VF) (n = 2). This noise interference persisted (n = 3), resolved spontaneously (n = 16), resolved with programming change (n = 6) or required lead revision (n = 1). Conclusions EMI from LVAD impacts ICD function, although, the incidence rate is low. Physicians implanting both, LVAD in patients with ICD (more common) or ICD in patients with LVAD, should be aware of possible interferences. Telemetry failure not resolved by metal shielding was overcome by ICD generator replacement to a different manufacturer. In most cases, LVAD‐related noise resolves spontaneously.

Managing ventricular arrhythmias and implantable cardiac defibrillator shocks after left ventricular assist device implantation

“…Telemetry communication issues between transvenous ICD and programmer have been reported to occur in 1.5%−14.7% of patients with CF‐LVADs 33,38 . Lead noise has been described in 3.5% of CF‐LVAD recipients with CIEDs and can be seen in RA, RV, and LV leads 39 . The noise is typically seen in the near field electrogram and not in the far field electrogram.…”

“…The noise is typically seen in the near field electrogram and not in the far field electrogram. Spatial proximity between CF‐LVAD and ICD; lead sensing configuration (dedicated vs. integrated bipolar sensing); speed of the impeller (with more noise at higher speed); and EMI amplification by device filters, are associated with inappropriate shocks or device inhibition 39,40 . Intrapericardial LVAD types (HVAD and HM3) are more prone for RV lead noise given proximity of the impeller to the lead 40,41 …”

“…33,38 Lead noise has been described in 3.5% of CF-LVAD recipients with CIEDs and can be seen in RA, RV, and LV leads. 39 The noise is typically seen in the near field electrogram and not in the far field electrogram. Spatial proximity between CF-LVAD and ICD; lead sensing configuration (dedicated vs. integrated bipolar sensing); speed of the impeller (with more noise at higher speed); and EMI amplification by device filters, are associated with inappropriate shocks or device inhibition.…”

Subcutaneous implantable cardioverter‐defibrillator noise following left ventricular assist device implantation

“… 12 Electromagnetic interference (EMI) between LVAD and TV‐ICD is an established phenomenon which can precipitate lead noise or telemetry interference, and inappropriate shocks. 13 , 14 The 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death recommend implantation of ICD in patients who are candidates for LVAD or OHT. 12 Therefore, the phenomenon of EMI in patients with LVAD and ICD is a significant clinical concern.…”

“…S‐ICD use is recommended in patients meeting criteria for defibrillator therapy 11 who lack adequate vascular access, are at a high risk for infection, or who do not have a current or anticipated need for bradycardia pacing, anti‐tachycardia pacing (ATP), or cardiac resynchronization therapy (CRT) 12 . Electromagnetic interference (EMI) between LVAD and TV‐ICD is an established phenomenon which can precipitate lead noise or telemetry interference, and inappropriate shocks 13,14 . The 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death recommend implantation of ICD in patients who are candidates for LVAD or OHT 12 .…”