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Clinical implications of left ventricular assist device implantation in patients with an implantable cardioverter-defibrillator

  • Fanny Boudghène-Stambouli
  • Stéphane Boulé
  • Céline Goéminne
  • Edward Botcherby
  • Christelle Marquié
  • Claude Kouakam
  • Laurence Guédon-Moreau
  • Guillaume Schurtz
  • Pascal de Groote
  • Nicolas Lamblin
  • Marie Fertin
  • Emmanuel Robin
  • François Brigadeau
  • Didier Klug
  • Dominique Lacroix
  • Jonathan Meurice
  • Ludivine Wissocque
  • André Vincentelli
  • Salem Kacet
Article

Abstract

Purpose

This study aims to study the clinical implications of the concomitant use of a left ventricular assist device (LVAD) and an implantable cardioverter-defibrillator (ICD).

Methods

In this retrospective study, all patients who underwent LVAD (Heart Mate II) implantation with concomitant ICD therapy at our institution between June 2007 and August 2012 were included. We sought to investigate (1) the electromagnetic interference between LVAD and ICD telemetry, (2) the effect of LVAD implantation on right ventricular (RV) lead parameters and (3) the ventricular tachyarrhythmias (VAs) that occur post-LVAD implantation.

Results

Of the 23 patients (53 ± 9 years, 73 % male, LVEF 19 ± 9 %) included, ICD telemetry was lost in four patients post-LVAD implantation (Saint-Jude-Medical Atlas V-193, V-240, V-243, and Sorin CRT-8750), prompting either use of a metal shield (n = 1), a change in position of the programmer head (n = 1) or ICD replacement (n = 2). LVAD implantation was associated with a decrease in both RV signal amplitude (p = 0.04) and RV impedance (p < 0.01), and a trend towards an increased RV pacing threshold (p = 0.08), without affecting clinical outcome. Eleven patients (47.8 %) experienced VAs after LVAD implantation, which on the whole were well tolerated. Their occurrence was strongly linked to a history of VAs before device implantation (p < 0.01).

Conclusions

Electromagnetic interference between LVADs and ICD telemetry may necessitate ICD replacement. LVAD placement is associated with significant changes in RV lead parameters that have minimal clinical significance. VAs occur in approximately half of LVAD patients seen and their occurrence is strongly related to a history of VAs prior to LVAD implantation.

Keywords

Left ventricular assist device Implantable cardioverter-defibrillator Lead Electromagnetic interference Ventricular tachycardia Ventricular fibrillation 

Abbreviations

CRT-D

Cardiac resynchronization therapy defibrillator

ICD

Implantable cardioverter-defibrillator

LVAD

Left ventricular assist device

LVEF

Left ventricular ejection fraction

LVEDD

Left ventricular end diastolic diameter

NYHA

New York Heart Association

RV

Right ventricular

VA

Ventricular tachyarrhythmia

Notes

Acknowledgments

The authors thank Nicolas Iscolo (Sorin Group) and Xavier Le Groumellec (Saint Jude Medical), for their help with technical information.

Conflict of interest

None

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Fanny Boudghène-Stambouli
    • 1
  • Stéphane Boulé
    • 1
    • 5
  • Céline Goéminne
    • 1
    • 3
  • Edward Botcherby
    • 1
  • Christelle Marquié
    • 1
  • Claude Kouakam
    • 1
  • Laurence Guédon-Moreau
    • 1
  • Guillaume Schurtz
    • 1
    • 2
  • Pascal de Groote
    • 1
  • Nicolas Lamblin
    • 1
    • 2
  • Marie Fertin
    • 1
  • Emmanuel Robin
    • 3
  • François Brigadeau
    • 1
  • Didier Klug
    • 1
    • 2
  • Dominique Lacroix
    • 1
    • 2
  • Jonathan Meurice
    • 1
  • Ludivine Wissocque
    • 1
  • André Vincentelli
    • 2
    • 4
  • Salem Kacet
    • 1
    • 2
  1. 1.Department of Cardiovascular medicineLille University HospitalLilleFrance
  2. 2.Faculty of MedicineUniversity of Lille 2LilleFrance
  3. 3.Department of Cardiovascular reanimationLille University HospitalLilleFrance
  4. 4.Department of Cardiovascular surgeryLille University HospitalLilleFrance
  5. 5.Pôle de Cardiologie, Hôpital CardiologiqueCHRULilleFrance

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