Left Ventricular Mechanical Assist Devices and Cardiac Device Interactions: An Observational Case Series

Autor:	Bruce D. Walker, Charles W. Thorburn, Peter S. Macdonald, Andre Tay, Christopher S. Hayward, Dennis L. Kuchar, Eugene Kotlyar, Philip Spratt, Paul Jansz, Anne Keogh, David Foo
Rok vydání:	2009
Předmět:	Adult Male Pacemaker Artificial medicine.medical_specialty Adolescent Defibrillation medicine.medical_treatment Ventricular tachycardia Young Adult Internal medicine medicine Humans Lead (electronics) Aged Retrospective Studies Heart transplantation business.industry General Medicine Middle Aged equipment and supplies medicine.disease Defibrillators Implantable Equipment Failure Analysis Treatment Outcome Ventricular Fibrillation Ventricular fibrillation cardiovascular system Cardiology Equipment Failure Female Observational study Heart-Assist Devices Implant Cardiology and Cardiovascular Medicine business Destination therapy
Zdroj:	Pacing and Clinical Electrophysiology. 32:879-887
ISSN:	1540-8159 0147-8389
DOI:	10.1111/j.1540-8159.2009.02403.x
Popis:	Background: Nonpulsatile left ventricular assist devices (LVADs) are increasingly used for treatment of refractory heart failure. A majority of such patients have implanted cardiac devices, namely implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy-pacemaker (CRT-P) or cardiac resynchronization therapy-defibrillator (CRT-D) devices. However, potential interactions between LVADs and cardiac devices in this category of patients remain unknown. Methods: We reviewed case records and device logs of 15 patients with ICDs or CRT-P or CRT-D devices who subsequently had implantation of a VentrAssist LVAD (Ventracor Ltd., Chatswood, Australia) as destination therapy or bridge to heart transplantation. Pacemaker and ICD lead parameters before and after LVAD implant were compared. In addition, ventricular tachyarrhythmia event logs and potential electromagnetic interference reports were evaluated. Results: Right ventricular (RV) sensing decreased in the first 6 months post-LVAD. Mean R-wave amplitude preimplant was 10.9 ± 5.25 mV compared with 7.2 ± 3.4 mV during follow-up (P = 0.02). RV impedance also decreased from 642 ± 240 ohms at baseline to 580 ± 212 ohms at follow-up (P = 0.007). There was a significant increase in RV stimulation threshold following implantation of the LVAD from 0.8 ± 0.6 V at baseline to 1.4 ± 1.0 V in the first 6 months postimplant (P = 0.01). A marked increase in ventricular tachyarrhythmia burden was observed in three patients. One patient displayed electromagnetic interference between the LVAD and defibrillator, resulting in inappropriate defibrillation therapy. Conclusions: LVADs have a definite impact on cardiac devices in respect with alteration of lead parameters, ventricular tachyarrhythmias, and electromagnetic interference.
Databáze:	OpenAIRE
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