Multicenter Experience of Concomitant Use of Left Ventricular Assist Devices and Subcutaneous Implantable Cardioverter-Defibrillators

Afzal, Muhammad R.; Ahmed, Asim S.; Prutkin, Jordan M.; Saba, Samir; Mei, Yong; Friedman, Paul A.; Knight, Bradley P.; Kanwar, Manreet; Lampert, Brent C.; Weiss, Raul

doi:10.1016/j.jacep.2018.05.002

Cited by 14 publications

(15 citation statements)

References 8 publications

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“…All cases involved either a heartware ventricular assist device (HVAD) (Medtronic, Minneapolis, MN) or HeartMate III LVAD with a pre‐existing S‐ICD. The absence of HeartMate II devices in this series is noteworthy, as 45% of LVAD patients with S‐ICD's had HeartMate II devices in the only large patient series published 14 ( P = .01 compared with the present cohort).…”

Section: Resultsmentioning

confidence: 56%

“…A total of 10 cases of EMI in LVAD patients with S‐ICD devices, including the three cases described above, have been reported 10‐15 . A summary of the demographic characteristics of these patients is shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The MAUDE database was also queried for reports of S‐ICD and LVAD interactions. Stochastic data are presented as percentages and Fisher's exact test was used to compare LVAD types between our cohort and the large case series published by Afzal et al 14 Continuous variables are reported as mean and standard deviation. P < .05 was considered statistically significant.…”

Section: Methodsmentioning

confidence: 99%

“…This has been shown to interfere with TV‐ICD function, particularly with device interrogation 9 . Less is known regarding the impact of EMI from LVADs on S‐ICD function, as it is limited to sporadic cases, in which oversensing with inappropriate shocks (IASs) were delivered 10‐15 . Accordingly, in the present study, we present three cases of EMI observed in S‐ICD patients with LVAD, as well as a review of the literature.…”

Section: Introductionmentioning

confidence: 95%

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

Ishida

Payne

Field

et al. 2020

Cardiovasc electrophysiol

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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

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Section: Resultsmentioning

confidence: 56%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

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

Ishida

Payne

Field

et al. 2020

Cardiovasc electrophysiol

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“…Patients underwent device implantation in the standard fashion using either a two-or three-incision approach as described previously. [8][9][10] Briefly, the lateral pocket incision was made at the mid-axillary line between the fourth and sixth intercostal space. Meticulous dissection was performed with electrocautery.…”

Section: Device Implantationmentioning

confidence: 99%

Implantation of subcutaneous defibrillator is feasible and safe with monitored anesthesia care

Afzal

Okabe

Koppert³

et al. 2019

Pacing Clinical Electrophis

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Background The perioperative anesthesia care during subcutaneous implantable cardioverter‐defibrillator (S‐ICD) implantation is still evolving. Objective To assess the feasibility and safety of S‐ICD implantation with monitored anesthesia care (MAC) versus general anesthesia (GA) in a tertiary care center. Methods This is a single‐center retrospective study of patients undergoing S‐ICD implantation between October 2012 and May 2019. Patients were categorized into MAC and GA group based on the mode of anesthesia. Procedural success without escalation to GA was the primary endpoint of the study, whereas intraprocedural hemodynamics, need of pharmacological support for hypotension and bradycardia, length of the procedure, stay in the post‐anesthesia care unit, and postoperative pain were assessed as secondary endpoints. Results The study comprises 287 patients with MAC in 111 and GA in 176 patients. Compared to MAC, patients in GA group were younger and had a higher body mass index. All patients had successful S‐ICD implantation. Only one patient (0.9%) in the MAC group was converted to GA. Despite a similar baseline heart rate (HR) and mean arterial blood pressure (MAP) in both groups, patients with GA had significantly lower HR and MAP during the procedure and more frequently required pharmacological hemodynamic support. Length of the procedure, stay in the postanesthesia care unit, and postoperative pain was similar in both groups. Conclusion This retrospective experience suggests that implantation of S‐ICD is feasible and safe with MAC. Use of GA is associated with more frequent administration of hemodynamic drugs during S‐ICD implantation.

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

Khetarpal

Javaid

Lee

et al. 2023

Journal of Arrhythmia

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Background:The incidence and impact of noise in a subcutaneous implantable cardioverter defibrillator (S-ICD) after left ventricular assist device (LVAD) implantation is not well established. Methods:We performed a retrospective study of patients implanted with LVAD and with a pre-existing S-ICD between January 2005 and December 2020 at the three Mayo Clinic centers (Minnesota, Arizona, and Florida).Results: Of the 908 LVAD patients, a pre-existing S-ICD was present in 9 patients (mean age 49.1 ± 13.7 years, 66.7% males), 100% with Boston Scientific third-generation EMBLEM MRI S-ICD, 11% with HeartMate II (HM II), 44% with HeartMate 3 (HM 3), and 44% with HeartWare (HW) LVAD. The incidence of noise from LVAD-related electromagnetic interference (EMI) was 33% and was only seen with HM 3 LVAD. Multiple measures attempted to resolve noise, including using alternative S-ICD sensing vector, adjusting S-ICD time zone, and increasing LVAD pump speed, were unsuccessful, necessitating S-ICD device therapies to be turned off permanently.

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Multicenter Experience of Concomitant Use of Left Ventricular Assist Devices and Subcutaneous Implantable Cardioverter-Defibrillators

Cited by 14 publications

References 8 publications

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

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

Implantation of subcutaneous defibrillator is feasible and safe with monitored anesthesia care

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

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