Device Interactions in Patients With Advanced Cardiomyopathy

Mehta, Rohit; Doshi, Amit A.; Hasan, Ayesha; Love, Charles J.; Pizzuto, Marg; Sai-Sudhakar, Chittoor; Chan, David P.

doi:10.1016/j.jacc.2008.01.025

Cited by 25 publications

(19 citation statements)

References 5 publications

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“…66 In addition, specific VAD models interfere with telemetry communication of some older ICDs. 68 This may be corrected by shielding the programmer, telemetry wand, and its cable. 69 MRI scanners generate fixed magnetic fields, and varying (gradient) magnetic fields, and radiofrequency fields.…”

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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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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“…[12][13][14] Reports have noted the negative LVAD-ICD interactions with St. Jude ICDs and pacemakers. [8][9][10][11] Thoratec Corporation has reported difficulty or inability to communicate with St. Jude implantable devices in patients with a HeartMate II LVAD, including: St. Jude Medical Integrity SR 5142 pacemaker, Atlas-HF V-341 ICD, Atlas-HF V-343 ICD, Atlas V193 ICD, and Atlas V-242 ICD. 15 In short, the HeartMate II pulse-width modulator, which operates at 7.2-kHz frequency and serves to regulate voltage input to the LVAD motor, interferes with the 8-kHz ICD telemetry interrogation.…”

Section: Discussionmentioning

confidence: 99%

“…15 In short, the HeartMate II pulse-width modulator, which operates at 7.2-kHz frequency and serves to regulate voltage input to the LVAD motor, interferes with the 8-kHz ICD telemetry interrogation. 10 St. Jude literature states that telemetry interference can occur between the HeartMate II LVAD and its older ICD systems, including the Photon, Epic, and Atlas ICDs, which operate continuously at 8 kHz. In addition, interference can also occur with newer St. Jude devices, including the Epic II, Atlas II, Current RF, and Promote RF ICDs, which operate at 8 kHz for approximately 100 ms during initial interrogation prior to switching to higher communication frequencies of 64 kHz and 402-405 MHz (the Medical Implant Communications Service frequency band).…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7] Previous reports have noted a potential and dramatic electromagnetic interference from LVADs on ICDs that causes impaired telemetry communication between the ICD and the programmer, ultimately necessitating explantation and generator replacement in order to resume communication between the programmer and ICD. [8][9][10][11] We report two cases of patients with ICD programming impairment caused by electromagnetic interference with their LVADs that was overcome by placing aluminum shielding around the ICD programmer wand and steel shielding around the extension cable during ICD interrogation. This strategy avoided ICD generator replacements.…”

Section: Introductionmentioning

confidence: 99%

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Overcoming Electromagnetic Interference by LVADs on ICD Function by Shielding the ICD Programmer Wand and Extension Cable

Biviano

Mancini

Naka

et al. 2009

Pacing Clinical Electrophis

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Patients with end-stage cardiomyopathy and congestive heart failure are increasingly undergoing implantation with left ventricular assist devices (LVADs). In addition, implantable cardioverter-defibrillator (ICD) therapy has been proven to be an important part of the treatment for cardiomyopathy/congestive heart failure. Previous reports have noted a potential and dramatic electromagnetic interference from LVADs on ICDs that cause impaired telemetry communication between the ICD and ICD programmer. Such interference has necessitated explantation and generator replacement in order to resume communication between the ICD and programmer. We report two patients with advanced congestive heart failure and ICD programming impairment caused by a HeartMate II LVAD (Thoratec Corporation, Pleasanton, CA, USA) that was overcome by placing aluminum shielding around the ICD programmer wand and steel shielding around the extension cable during ICD interrogation.

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“…However, in our case, the patient was implanted with a new generation of SJM CRT-D (which uses an operating frequency of 64 kHz). According to the explanation given in the correspondence from Mehta et al (1), no interaction would have been expected. In fact, the Federal Communications Commission who regulates the operating frequencies of all implantable devices has mandated device operating in UHF bands to use a "listen-before-talking" (LBT) accessing protocol for safety reasons (2).…”

Section: Device Interactions and Cardiomyopathymentioning

confidence: 92%

Device Interactions and Cardiomyopathy

Waroux¹,

Marchandise²,

Scavée³

2008

Journal of the American College of Cardiology

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We read with much interest the Research Correspondence by Mehta et al. (1) of 2 cases of device interactions in patients with advanced cardiomyopathy. We experienced the same problem with a patient equipped with a St. Jude Medical (SJM) implantable cardioverter-defibrillator (Atlas II ϩ HF, model V-367, St. Jude Medical, Sunnyvale, California) who was implanted with a Heartmate II left ventricular assist device (LVAD) (Thoratec Heartmate II, Thoratec, Pleasanton, California). Similar to the 2 cases reported by the group of Mehta et al. (1), our case demonstrated no possible telemetry after the implantation of the LVAD pump, and the replacement of the implantable cardioverter-defibrillator (ICD) was the only clinical solution. Mehta et al.(1) partially clarified the nature of the interaction. We also found that it was specifically produced by the Heartmate II pulse-width modulator, which operates at a constant frequency of 7.2 kHz. However, in our case, the patient was implanted with a new generation of SJM CRT-D (which uses an operating frequency of 64 kHz). According to the explanation given in the correspondence from Mehta et al.(1), no interaction would have been expected. In fact, the Federal Communications Commission who regulates the operating frequencies of all implantable devices has mandated device operating in UHF bands to use a "listen-before-talking" (LBT) accessing protocol for safety reasons (2). All ICDs, even the last Current and Promote generation from SJM, use an LBT assessing protocol operating at a frequency of 8 kHz (communication from SJM Belgium, St. Jude Medical, Zaventem, Belgium, April 2008) (Table 1). Interactions could thus occur either between the pulse-width modulator and the LBT protocol (newest generation) and/or the data transmission per se (oldest generation). This was clearly demonstrated by clinical tests that we performed with demonstration devices: the initial interrogation of all SJM ICDs is always impossible if the distance between the ICD and the LVAD pump is shorter than 6 inches. However, the communication to the device is possible close to the Heartmate for the newest generation of SJM ICDs (LBT: 8 kHz; operating frequency: 64 kHz) if the initial recognition of the ICD is established far away from the LVAD pump. By contrast, with the oldest generation of SJM devices (LBT and operating frequency: 8 kHz), communication in proximity of the Heartmate remained unavailable even if the initial recognition is performed far away from the LVAD pump. The operating frequency of an ICD is thus not the only mechanism that explains the inability to interrogate the SJM ICDs in proximity of the Heartmate II LVAD pump. Other potential sources of interactions (such as the LBT frequency used) should be taken into account before choosing a replacement device. In our opinion, device interactions are important factors that should be recognized by manufacturers who are required to provide safety information about this specific risk. ReplyDr. Le Poland de Waroux and colleagues have described an...

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Device Interactions in Patients With Advanced Cardiomyopathy

Cited by 25 publications

References 5 publications

Troubleshooting Implanted Cardioverter Defibrillator Sensing Problems I

Troubleshooting Implanted Cardioverter Defibrillator Sensing Problems I

Overcoming Electromagnetic Interference by LVADs on ICD Function by Shielding the ICD Programmer Wand and Extension Cable

Device Interactions and Cardiomyopathy

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