Electromagnetic interference from left ventricular assist devices in patients with subcutaneous implantable cardioverter‐defibrillators

Abstract

Introduction: Interactions of left ventricular assist devices (LVADs) with transvenous implantable cardioverter-defibrillator systems (ICDs) have been widely reported. However, less is known regarding the impact of electromagnetic interference (EMI) from LVADs on subcutaneous ICD function.Methods and Results: A comprehensive literature search was performed on PubMed, Cochrane central registry, and Google Scholar using the search terms "subcutaneous implantable cardioverter-defibrillator and left ventricular assist devices," "electromagnetic interference, LVAD, and subcutaneous ICD," "EMI and S-ICD," and "inappropriate shocks, LVAD, and ICD." Demographic and programming data were extracted from the reports and authors as needed. A total of seven cases of EMI in LVAD patients with subcutaneous ICD (S-ICD) devices were found. In addition three previously unreported cases from our center were included. All cases involved either a heartware ventricular assist device or HeartMate III LVAD with a pre-existing S-ICD. In all patients, both the primary and secondary vectors had inappropriate sensing due to EMI. Three patients were reprogramed to the alternate vector with appropriate sensing. The S-ICD was either inactivated or replaced with a transvenous device in six patients. A single patient was left sensing in the alternate vector. There were no reports of inability to interrogate S-ICD systems in patients with LVADs. Conclusion:The risk of inappropriate shocks from LVADs should be considered in pre-existing patients with S-ICD, particularly when the heartware ventricular assist device or HeartMate III LVAD device is present. Reprogramming of the sensing vector can occasionally avoid this issue but often the S-ICD needs to be inactivated. K E Y W O R D S electromagnetic interference, inappropriate shock, left ventricular assist device, oversensing, subcutaneous implantable cardioverter-defibrillator

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

“…11 Nevertheless, there have been several reports of device-device interference between LVADs and conventional ICD systems 12,13 as well as inappropriate S-ICD sensing after LVAD implantation in S-ICD carriers leading to inappropriate ICD therapy. 9,14,15 Thus, awareness and caution in the setting of coexistence of LVAD and S-ICD was raised.…”

“…S‐ICD therapy can be an alternative to transvenous ICD systems in patients with LVAD, since device‐related infections and lead failures pose major challenges in these patients 11 . Nevertheless, there have been several reports of device‐device interference between LVADs and conventional ICD systems 12,13 as well as inappropriate S‐ICD sensing after LVAD implantation in S‐ICD carriers leading to inappropriate ICD therapy 9,14,15 . Thus, awareness and caution in the setting of coexistence of LVAD and S‐ICD was raised.…”

“…However, ECG quality and interpretation are often challenging in patients with LVAD mainly due to artifacts (Figure 1). More specifically, potential electromagnetic interference (EMI) of S-ICD and LVAD leading to oversensing by the S-ICD has been repeatedly reported 8,9 but cannot be simulated by the available screening methods.…”

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

“…Second, the data was limited to study of LVAD‐related EMI in transvenous ICDs only and did not include subcutaneous or epicardial ICDs. EMI in subcutaneous ICDs 26,27 is an emerging phenomenon; however, may occur by mechanisms different from transvenous ICD and is best studied separately. The conclusions may not be extrapolated to subcutaneous ICD devices.…”

Premature end of service of implantable cardioverter-defibrillator by magnetic interference with left-ventricular assist device

“… 2 This coexistence of 2 neighboring implanted electrical devices increases the risk of relevant device-device interactions. Several case reports previously described electromagnetic interference of LVAD and ICD systems that result in oversensing leading to inappropriate ICD therapy 3 or an impaired telemetry communication between the ICD and ICD programmer during LVAD support. 4 , 5 , 6 To avoid generator explantation and replacement, several strategies, including changes in body position and shielding methods to establish a pseudo–Faraday cage, have been proposed.…”