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Appropriate and inappropriate ICD shocks in patients with LVADs: Prevalence, associated factors, and etiologies.

Publication ,  Journal Article
Andreae, A; Black-Maier, E; Arps, K; Kobe, E; Johnson, T; Shrader, P; Holmes, D; Towery, E; Sun, A; Friedman, DJ; Koontz, J; Schroder, J ...
Published in: Heart Rhythm
February 2025

BACKGROUND: Implantable cardioverter-defibrillator (ICD) shocks are a common complication after left ventricular assist device (LVAD) implantation; however, data on their frequency and causes are limited. OBJECTIVE: The purpose of this study was to define the incidence, programming, patient characteristics, and factors associated with appropriate and inappropriate ICD shocks in persons with LVADs. METHODS: We performed a retrospective review at Duke University Hospital of all LVAD recipients implanted between January 1, 2013, to June 30, 2019, with a preexisting ICD. ICD shocks were adjudicated by the treating physician and a second reviewer for the purpose of this study. RESULTS: Among 421 patients with an ICD in situ undergoing LVAD implant, 147 (33.9%) had at least 1 shock after LVAD implantation. Among 134 patients with complete device history, a total of 330 shock episodes occurred: 255 (77.3%) appropriate and 75 (22.7%) inappropriate. Etiologies for inappropriate shocks included supraventricular tachycardia (n = 66 [20.0%]), physiological oversensing (n = 1 [0.3%]), and nonphysiological oversensing (n = 8 [2.4%]) including LVAD electromagnetic interference (n = 1 [0.3%]). ICD programming with shorter detection delay (P <.001) and absence of antitachycardia pacing programming (P = .001) in high-rate zones was seen more commonly in inappropriate shock than appropriate shock. CONCLUSIONS: The rate of inappropriate shocks in LVAD recipients is very high and most often is due to supraventricular arrhythmias. LVAD electromagnetic interference is a rare cause of ICD shock. Implementation of current consensus American Heart Association recommendations for LVAD programming with long detection delays and high rate cutoffs may help prevent inappropriate ICD shocks.

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Published In

Heart Rhythm

DOI

EISSN

1556-3871

Publication Date

February 2025

Volume

22

Issue

2

Start / End Page

394 / 402

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Prevalence
  • Middle Aged
  • Male
  • Incidence
  • Humans
  • Heart-Assist Devices
  • Heart Failure
  • Follow-Up Studies
 

Citation

APA
Chicago
ICMJE
MLA
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Andreae, A., Black-Maier, E., Arps, K., Kobe, E., Johnson, T., Shrader, P., … Piccini, J. (2025). Appropriate and inappropriate ICD shocks in patients with LVADs: Prevalence, associated factors, and etiologies. Heart Rhythm, 22(2), 394–402. https://doi.org/10.1016/j.hrthm.2024.07.099
Andreae, Andrew, Eric Black-Maier, Kelly Arps, Elizabeth Kobe, Trevor Johnson, Peter Shrader, DaJuanicia Holmes, et al. “Appropriate and inappropriate ICD shocks in patients with LVADs: Prevalence, associated factors, and etiologies.Heart Rhythm 22, no. 2 (February 2025): 394–402. https://doi.org/10.1016/j.hrthm.2024.07.099.
Andreae A, Black-Maier E, Arps K, Kobe E, Johnson T, Shrader P, et al. Appropriate and inappropriate ICD shocks in patients with LVADs: Prevalence, associated factors, and etiologies. Heart Rhythm. 2025 Feb;22(2):394–402.
Andreae, Andrew, et al. “Appropriate and inappropriate ICD shocks in patients with LVADs: Prevalence, associated factors, and etiologies.Heart Rhythm, vol. 22, no. 2, Feb. 2025, pp. 394–402. Pubmed, doi:10.1016/j.hrthm.2024.07.099.
Andreae A, Black-Maier E, Arps K, Kobe E, Johnson T, Shrader P, Holmes D, Towery E, Sun A, Friedman DJ, Koontz J, Schroder J, Milano C, Khouri MG, Katz JN, Agarwal R, Russell SD, Pokorney S, Daubert J, Piccini J. Appropriate and inappropriate ICD shocks in patients with LVADs: Prevalence, associated factors, and etiologies. Heart Rhythm. 2025 Feb;22(2):394–402.
Journal cover image

Published In

Heart Rhythm

DOI

EISSN

1556-3871

Publication Date

February 2025

Volume

22

Issue

2

Start / End Page

394 / 402

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Prevalence
  • Middle Aged
  • Male
  • Incidence
  • Humans
  • Heart-Assist Devices
  • Heart Failure
  • Follow-Up Studies