1. ICD-VAD Compatibility, Could You End up with a Deaf ICD after VAD Implantation?
- Author
-
James Nadel, S. Baldinger, N. Kaufmann, Bruno Schnegg, Desiree Robson, Thomas Meredith, Christopher S. Hayward, and O. Wigger
- Subjects
Pulmonary and Respiratory Medicine ,Transplantation ,medicine.medical_specialty ,business.industry ,Defibrillation ,medicine.medical_treatment ,Guideline ,medicine.disease ,Lower threshold ,Ventricular assist device ,Heart failure ,Ventricular fibrillation ,Medicine ,Communication problem ,Surgery ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine - Abstract
Purpose Most heart failure patients undergoing ventricular assist device (VAD) implantation are managed with guideline-based therapy including the implantation of defibrillation capable device (ICD). Prior to surgery, programming allowing therapy with lower threshold could be lifesaving. After surgery, the defibrillator should be reprogrammed to protect the patient against painful, unnecessary shocks, as the circulation will be supported even in ventricular fibrillation. Difficulties in interrogation of ICD in patients with both HeartMate-II and HeartMate3 devices have been previously reported, related to the VAD-produced electromagnetic interference. Most cases result in a problem of communication between the ICD and the corresponding interrogating console. Methods An electronic search was performed to identify all articles and abstracts published on the topic until July 2019. To the list, we added one case from our clinical experience as well as manufacturer described cases of incompatibility. Results We identified 473 publications. Fourteen publications were ultimately included. Those publications described 22 patients with device interrogation issues post VAD implantation. To regain control of the device complete replacement of the ICD/CRT/PM was performed in 10 patients, and in one the implantation side was changed. In 11 cases a shielding technique was successfully utilized. From the data, we can extract the names of 14 devices with a documented communication problem. There were no reported cases of adverse interaction between HeartWare and ICDs. Conclusion Given the reported VAD-associated EMI interaction with ICD interrogation due to interruption of the handshake-signal to initiate ICD interrogation, it is likely all the variants of one specific ICD (1 lead, 2 lead, CRT) will also suffer from the same problem. More ex-vivo research is needed to better understand the phenomenon, and clinicians and patients with the listed ICDs need to be aware of the potential loss of ICD control with HM2 or HM3.
- Published
- 2020
- Full Text
- View/download PDF