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Electromagnetic interference from left ventricular assist device in patients with transvenous implantable cardioverter‐defibrillator
Author(s) -
Khetarpal Banveet Kaur,
Lee Justin Z.,
Javaid Awad I.,
Mi Lanyu,
Venepally Nithin Rao,
Narasimhan Bharat,
Hardaway Brian W.,
Cha YongMei,
Kusumoto Fred,
Mulpuru Siva K.,
Srivathsan Komandoor
Publication year - 2021
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14265
Subject(s) - medicine , cardiology , implantable cardioverter defibrillator , ventricular fibrillation , ventricular tachycardia , ventricular assist device , electromagnetic interference , heart failure , telecommunications , computer science
Background Many advanced heart failure patients have both a left ventricular assist device (LVAD) and an implantable cardioverter‐defibrillator (ICD). This study examines incidence, clinical impact, and management of LVAD‐related EMI. Methods We performed a three‐center retrospective analysis of transvenous ICD implanted patients with LVAD implanted between January 1, 2005 and December 31, 2020. The primary outcome was EMI after LVAD implantation, categorized as LVAD‐related noise or telemetry interference. Results The rate of LVAD‐related EMI among the 737 patients (mean age 58.6 ± 12.8 years) studied was 5.0%. Telemetry interference (1.5%) compromised ICD interrogation in all patients. This was resolved successfully with use of a metal shield, encased wand, radiofrequency tower, different ICD programmer or by increasing distance between ICD programmer and LVAD ( n = 6). ICD replacement was required to reestablish successful communication in three patients. LVAD‐related noise (3.5%) led to oversensing ( n = 4), inappropriate mode switches ( n = 4), noise reversion ( n = 3), inhibition of pacing ( n = 2), inappropriate detection as atrial fibrillation (AF) (n = 2) and inappropriate detection as ventricular tachycardia (VT) and/or ventricular fibrillation (VF) ( n = 2). This noise interference persisted ( n = 3), resolved spontaneously ( n = 16), resolved with programming change ( n = 6) or required lead revision ( n = 1). Conclusions EMI from LVAD impacts ICD function, although, the incidence rate is low. Physicians implanting both, LVAD in patients with ICD (more common) or ICD in patients with LVAD, should be aware of possible interferences. Telemetry failure not resolved by metal shielding was overcome by ICD generator replacement to a different manufacturer. In most cases, LVAD‐related noise resolves spontaneously.