Subcutaneous implantable cardioverter defibrillators in patients with left ventricular assist devices: case report and comprehensive review

Abstract

Background Left ventricular assist devices (LVAD) are increasingly used in patients with advanced heart failure, many of whom have been or will be implanted with an implantable cardioverter defibrillator (ICD). Interaction between both devices is a matter of concern. Subcutaneous ICD (S-ICD) obtains its signals through subcutaneous vectors, which poses special challenges with regards to adequate performance following LVAD implantation. Case summary We describe the case of a 24-year-old man implanted with an S-ICD because of idiopathic dilated cardiomyopathy, severe biventricular dysfunction, and self-limiting sustained ventricular tachycardias. After the implantation of a HeartMate 3™ (Left Ventricular Assist System, Abbott) several months later, the S-ICD became useless because of inappropriate sensing due to electromagnetic interference and attenuation of QRS voltage. Discussion We reviewed the reported cases in PubMed about the concomitant use of S-ICD and LVAD. Seven case reports about the performance of S-ICD in patients with an LVAD were identified, with discordant results. From these articles, we analyse the potential causes for these differing results. Pump location and operating rates in LVAD, as well as changes in the subcutaneous-electrocardiogram detected by the S-ICD after LVAD implantation are related to sensing disturbances when used in the same patient.

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

“…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.…”

“…In addition to the amplitude of the EMI signal that may be dependent on the LVAD location, the frequency of these signal may also be important. HeartMate II operates at higher rates than HVAD and HeartMate III, generating a signal with the main frequency bordering on the band‐pass filters of the S‐ICD 15 …”

“…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.…”

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.…”

De novo subcutaneous implantable cardioverter-defibrillator in patient with left ventricular assist device

“… 1 , 2 In addition, the subcutaneous implantable cardioverter-defibrillator (S-ICD) has emerged as an alternative to transvenous ICD to avoid lead-related or infection-related complications. 3 , 4 The use of S-ICD in patients with LVADs has been described in case reports with mixed levels of interference due to the electromagnetic interference (EMI) generated by the LVAD. This is mostly device related, with HeartMate II (Abbott, North Chicago, IL) having less reported interference than HeartWare HVAD (Medtronic, Miramar, FL) or HeartMate 3 (Abbott, North Chicago, IL).…”