Subcutaneous implantable cardioverter-defibrillator troubleshooting in patients with a left ventricular assist device: A case series and systematic review.

Journal Article (Journal Article;Systematic Review)

BACKGROUND: There are limited data on the performance of the subcutaneous implantable cardioverter-defibrillator (S-ICD) in patients with a left ventricular assist device (LVAD). OBJECTIVE: The purpose of this study was to describe the clinical course and outcomes of patients with both an S-ICD and an LVAD 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: Of 588 patients undergoing LVAD implantation with a preexisting implantable cardioverter-defibrillator, 4 had an S-ICD in situ after LVAD implantation. All 4 patients developed electromagnetic interference (EMI) in the primary/secondary vectors after LVAD implantation, resulting in inappropriate implantable cardioverter-defibrillator shocks in 2 patients. Sensing in the alternate vector was adequate immediately postoperatively in 1 patient. Postoperative 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 reenabled. Eight studies involving 27 patients were identified in the systematic review. EMI was common and frequently absent in the alternate vector (6 of 7 patients). CONCLUSION: Undersensing and EMI are common after LVAD implantation in patients with an S-ICD in situ, particularly in the primary and secondary sensing vectors. Undersensing in the alternate vector may improve during follow-up, obviating the need for device revision or extraction.

Full Text

Duke Authors

Cited Authors

  • Black-Maier, E; Lewis, RK; Barnett, AS; Pokorney, SD; Sun, AY; Koontz, JI; Daubert, JP; Piccini, JP

Published Date

  • September 2020

Published In

Volume / Issue

  • 17 / 9

Start / End Page

  • 1536 - 1544

PubMed ID

  • 32304733

Electronic International Standard Serial Number (EISSN)

  • 1556-3871

Digital Object Identifier (DOI)

  • 10.1016/j.hrthm.2020.04.019


  • eng

Conference Location

  • United States