Subcutaneous implantable cardioverter-defibrillator troubleshooting in patients with left ventricular assist devices: a case series and systematic review
Abstract
BACKGROUND
There are limited data on the performance of the subcutaneous implantable cardioverter defibrillator (S-ICD) in patients with left ventricular assist devices (LVADs).
OBJECTIVE
To describe the clinical course and outcomes of patients with both S-ICD and LVAD devices at our institution and via a systematic review of published studies.
METHODS
We performed a retrospective cohort study of all patients who underwent LVAD implantation from 2009 to 2019 at Duke University Hospital. We also performed a systematic review of studies involving patients with an S-ICD and LVAD using the PUBMED/EMBASE databases.
RESULTS
Among 588 patients undergoing LVAD implant with a pre-existing ICD, 4 had an S-ICD in situ following LVAD implantation. All 4 patients developed EMI in the primary/secondary vectors following LVAD implant, resulting in inappropriate ICD shocks in 2 patients. Sensing in the alternate vector was adequate immediately post-operatively in 1 patient. Post-operative undersensing was present in the alternate vector in 3 patients, but improved at first outpatient follow up in 2 patients, allowing tachy-therapies to be re-enabled. Eight studies involving 27 patients were identified in systematic review. EMI was common and frequently absent in the alternate vector (6 of 7 patients).
CONCLUSIONS
Undersensing and electromagnetic interference (EMI) are common after LVAD implantation in patients with a S-ICD in situ, particularly in the primary and secondary sensing vectors.…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 588 participants or records.
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