Heart Rhythm O2 (Dec 2021)

Implantable cardioverter-defibrillator–related procedures and associated complications in continuous flow left ventricular assist device recipients: A multicenter experience

  • Ashwin Ravichandran, MD,
  • Naga Venkata K. Pothineni, MD,
  • Jaimin R. Trivedi, MD, MPH,
  • Henri Roukoz, MD,
  • Mustafa M. Ahmed, MD,
  • Adarsh Bhan, MD,
  • Geetha Bhat, MD,
  • Jennifer Cowger, MD,
  • Amin Al Ahmad, MD, FHRS,
  • Andrea Natale, MD, FHRS,
  • Luigi Di Biase, MD, FHRS,
  • Mark S. Slaughter, MD,
  • Dhanunjaya Lakkireddy, MD, FHRS,
  • Rakesh Gopinathannair, MD, MA, FHRS

Journal volume & issue
Vol. 2, no. 6
pp. 691 – 697

Abstract

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Background: Limited data exist regarding complication rates of implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy devices (CRT-D) in patients with left ventricular assist devices (LVAD). Objective: We describe the incidence and characteristics of ICD- and CRT-D-related procedures and complications in a multicenter LVAD cohort. Methods: A total of 537 LVAD patients with a pre-existing ICD or CRT-D from 5 centers were included. Details on device type, device therapies, procedural complications, and long-term survival were analyzed. Results: Of 537 patients, 280 had a CRT-D and 257 had ICD only. During a median follow-up of 538 days, 126 patients underwent generator replacement with significantly higher rate in the CRT group (79 [28.2%] vs 47 [18.3%], P = .0006). Device-related complications occurred in 36 (13%) CRT-D and 20 (8%) ICD patients (P = .06). Incidence of pocket hematoma (3.2% vs 2.7%), infection (4.3% vs 1.6%), and lead malfunction (3.1% vs 2.8%) was similar in both groups, with no effect of device complication on long-term survival (log-rank P = .7). There was a higher incidence of post-LVAD antitachycardia pacing for ventricular arrhythmias in the CRT-D group compared to the ICD group (35% vs 26%, P = .03). Conclusion: Cardiac implantable electronic device–related procedures are common in LVAD patients. Compared to ICD only, continued CRT-D therapy post-LVAD results in a significantly higher number of generator changes and a trend towards higher device- or lead-related complications. Device-related complications were not associated with reduced survival.

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