A novel screening tool to unmask potential interference between S‐ICD and left ventricular assist device

Abstract

Introduction: In patients with a left ventricular assist device (LVAD), the subcutaneous implantable cardioverter-defibrillator (S-ICD) can be an alternative to transvenous ICD systems due to reduced risk of systemic infection, which could lead to extraction of the ICD as well as the LVAD. S-ICD eligibility is lower in patients with LVAD than in patients with end-stage heart failure without LVAD. Several reports have shown inappropriate S-ICD therapy in the coexistence of LVAD and S-ICD. The aim of the present study was to evaluate S-ICD eligibility in patients with LVAD using the established electrocardiogram (ECG)-based screening test as well as a novel device-based screening test to identify potentially inappropriate S-ICD sensing in this specific patient cohort. Methods and Results: The present study included 115 patients implanted with an LVAD. The standard ECG-based screening test and a novel device-based screening test were performed in all patients. Eighty patients (70%) were eligible for S-ICD therapy with the standard ECG-based screening test. Performance of the novel device-based screening test identified device-device interference in 14 of these 80 patients (12%). Conclusion: Using a novel extended device-based S-ICD screening method, a small number of patients with LVAD deemed eligible for S-ICD with the standard ECG-based screening test exhibit device-device interference. Careful S-ICD screening should be performed in patients with LVAD, who are candidates for S-ICD therapy, to prevent inappropriate sensing or ICD therapy.

Changes in eligibility for a subcutaneous cardioverter-defibrillator after implantation of a left ventricular assist device–A prospective analysis

“…In order to unravel potential device-device interference between S-ICD and LVAD, we also performed the device-based screening test. The device-based screening test uses a functional S-ICD generator connected to an S-ICD lead and fixed in the appropriate position with adhesive tape and contact gel as previously described [ 10 ]. This screening test aims to better imitate an implanted S-ICD system in situ and allows to test for correct sensing and potential electromagnetic interference.…”

“…Previous studies have shown that S-ICD eligibility in patients with LVAD is lower compared to patients with heart failure in general [ 5 , 10 ]. A novel device-based S-ICD screening tool was found to unravel potential device-device interference between LVAD and S-ICD [ 10 , 11 ].…”

“…Previous studies have shown that S-ICD eligibility in patients with LVAD is lower compared to patients with heart failure in general [ 5 , 10 ]. A novel device-based S-ICD screening tool was found to unravel potential device-device interference between LVAD and S-ICD [ 10 , 11 ]. Nevertheless, no data are available as to which extent the implantation of an LVAD itself impacts S-ICD eligibility, which is especially relevant for patients who are candidates for an LVAD.…”

“…The present study aimed to prospectively evaluate S-ICD eligibility in patients undergoing LVAD implantation. S-ICD eligibility was examined using the standard ECG based S-ICD screening test as wells as a novel device-based S-ICD screening test, previously described by our group [ 10 ].…”

Author reply: S‐ICD eligibilities in adults with congenital heart disease

“…Cases of the automated screening test unable to deliver a result have been previously reported and are often due to paced QRS complex, low R wave amplitudes, and electromagnetic interferences. 8,9 The ECG-based screening test was performed as standard of care, but was not the main focus of our study, since this has already been largely examined in ACHD patients in previous studies. 2,3,5,7,10 Furthermore, Wang et al propose a comparison of S-ICD eligibility in different positions (standing and supine) on the left and right parasternal position using McNemar's chi-square test.…”