Background: Patients with left ventricular assist devices (LVADs) often have cardiac implantable electronic devices (CIED) for primary and secondary prevention. The role of CIED in this population is debated since many patients are hemodynamically stable while in ventricular tachycardia. Consequently, CIED related procedures are unclear in this population, given the potential devastating complications of bleeding and infection.
Objective: The objective of this study is to determine if patients with LVADs are at increased risk of complications from CIED implantation, generator changes or revisions.
Methods: This was a retrospective, multicenter study from 01/01/12 to 09/30/18 that included St Vincent Hospital, the Cleveland Clinic, Scripps Health, MedStar Washington Hospital Center, California Pacific Medical Center and Penn Presbyterian Medical Center. All patients with LVAD were screened and those that had a CIED generator change (GC), implantation or revision, were included in the study and followed until 12/31/18.
Results: A total of 179 patients had a CIED procedure after LVAD implantation. The mean age was 59.5 ± 13.4, with the cohort compromising of a 78% male, 54% destination therapy population. CIED procedures comprised of GC (66%), new CIED implant (26%), GC with lead revision (5%) or lead implant/revision (3%). The 30-day complication rates were 16% for pocket hematoma, 2% for CIED infection, 1% for pericardial effusion, 1% for pneumothorax, and 1% for bloodstream infection. The mean INR at the time of procedure was 1.98 ± 0.63 and 5% patients received bridging anticoagulation. During 1-year follow-up, 24% (n = 42) of patients received appropriate device therapy (DT) and 54.8% of those had appropriate DT previously. Of the 126 patients without previous DT, 14.3% received appropriate DT during follow-up.
Conclusion: In this large, multicenter cohort, we report the incidence of complications for CIED procedures in the LVAD population; specifically, LVAD patients are at increased risk of pocket hematomas, without downstream risk of infection. Notably, patients with primary prevention devices had a low rate of DT. Larger, prospective trials are needed to further characterize the utility and risk of CIED procedures in the LVAD population.