The following is a summary of “Left ventricular assist device in the presence of subcutaneous implantable cardioverter defibrillator: Data from a multicenter experience,” published in the January 2024 issue of Cardiology by Migliore et al.
Left ventricular assist devices (LVADs) have emerged as a crucial strategy for managing advanced heart failure (HF). At the same time, the subcutaneous implantable cardioverter defibrillator (S-ICD) represents a potential alternative to traditional ICDs, carrying a lower risk of both short- and long-term device-related complications and infections. This multicenter study aimed to assess the outcomes and management of patients with preexisting S-ICDs who underwent LVAD implantation for advanced HF despite optimal medical therapy. The study cohort comprised 30 patients (25 male; median age 45 [38–52] years), with the HeartMate III being the predominant LVAD type. Over a median follow-up of 7 months (1–20), no issues were reported regarding the ability to interrogate S-ICD systems.
However, electromagnetic interference (EMI) was noted in 70% of patients, with the primary sensing vector significantly influencing EMI occurrence. While 90% of patients remained eligible for S-ICD implantation with at least one optimal sensing vector, 10% were deemed ineligible despite attempts to reprogram sensing vectors. In the postoperative period, six patients (20%) experienced inappropriate shocks due to EMI, and an additional six (20%) encountered appropriate shocks. No S-ICD extraction was necessary due to anti-tachycardia pacing, ineffective therapy, or infection.
This study concludes that the simultaneous use of LVAD and S-ICD is generally feasible. Still, careful consideration must be given to potential risks such as EMI-related over-sensing and inappropriate shocks in the post-LVAD implantation phase. A meticulous screening for EMI is crucial across all sensing vectors post-LVAD implantation to ensure optimal patient safety and device performance.
Source: sciencedirect.com/science/article/abs/pii/S0167527324001724
