Cardiovascular Implantable Electronic Devices -> Tachycardia Devices: -> Clinical Trials D-PO06 - Poster Session VI (ID 26) Poster

D-PO06-031 - Prevalence Of Unsuccessful Automatic Implantable Cardioverter-Defibrillations In Left Ventricular Assist Device Patients (ID 1348)

Abstract

Background: Patients with end-stage heart failure who undergo left ventricular assist device (LVAD) implantation often have automated implantable cardioverter-defibrillators (AICD). LVAD patients are subject to ventricular arrhythmias such as ventricular tachycardia (VT) and ventricular fibrillation, even though the LVAD provides the hemodynamic support to survive these arrhythmias. Ventricular arrhythmias are usually terminated by AICD defibrillation, however it is unclear whether LVAD placement adversely affects AICD defibrillation efficacy and if they are associated with unsuccessful defibrillation.
Objective: To evaluate clinical characteristics and outcomes of patients with LVAD who have unsuccessful and successful AICD defibrillation for ventricular arrhythmias.
Methods: A Columbia University Institutional Review Board approved a ten-year retrospective analysis of medical records performed on 155 patients with AICDs who underwent LVAD placement at Columbia University Medical Center between 2009 and 2019.
Results: Forty-one patients that had an AICD firing following LVAD were identified. Ninety-five percent male, 63% Caucasian, average age 61.5 +/- 11.2 years, average LVEF 17.1% +/- 6 %, 56% with ischemic cardiomyopathy, 66% with Heartmate II and 29% with Heartmate III were analyzed. Fourteen (34%) patients had unsuccessful shocks post-LVAD implantation. Of the patients with unsuccessful shocks, 71% of patients had a history of ischemic cardiomyopathy. Fifteen (39%) patients had a >50% decrease in RV sensing amplitude after LVAD implantation without significant changes in impedance or threshold.
Conclusion: LVAD implantation in end-stage heart failure patients may be associated with unsuccessful AICD defibrillation for ventricular arrhythmias. Further research is warranted to further characterize mechanisms that may contribute to unsuccessful shocks post-LVAD placement and if defibrillation threshold testing should be performed after LVAD placement.
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