Cardiovascular Implantable Electronic Devices -> Monitoring & Outcomes: -> Quality Measures & Complications D-AB04 - Innovations, Nuances and Critical Questions in CIED Management Therapies (ID 33) Abstract

D-AB04-06 - Newer Generation Left Ventricular Assist Devices Can Adversely Affect Right Ventricular ICD Lead Performance (ID 1408)


Background: Transvenous ICDs are frequently present at the time of Ventricular Assist Device (VAD) implantation. Many of these patients have underlying rhythms which depend on the pacing function. Newer generation VADs are placed within the pericardium, at the RV apex, which may impact lead function to a greater degree than observed with older generation VADs.
Objective: To determine the effect on VAD implantation on RV ICD lead performance.
Methods: Retrospective analysis of all patients with an ICD who underwent VAD implantation at Mount Sinai Hospital from 2015-2019. Device interrogations were performed immediately before and after VAD implantation, as well as most recent interrogation. A clinically significant increase in pacing threshold was defined as an increase ≥2 mV.
Results: Of the 61 evaluable patients with intra-pericardial VADs, 20% (n=12) had a significant increase in pacing threshold (0.93 mV pre-VAD vs 5.2 mV post-VAD, P < 0.001). These patients also demonstrated a change in sensing (12.77 mV vs 2.95 mV, P < 0.001) with a smaller but significant change impedance (510 ohms vs 803 ohms, P = 0.02). Device manufacturer, type of ICD or surgical approach did not affect these outcomes. Data was available in 45 patients with an older generation VAD (extra-pericardial), which had lower rates of threshold changes (9%), and to a lesser magnitude (0.98 mV vs 3.7 mV, P = 0.013).
Conclusion: The newer generation (intra-pericardial) VADs appear to be associated with a higher incidence of abnormal RV lead function. The mechanism is unclear and warrants further investigation, but may be related to differences in functional characteristics and/or proximity between the lead and the VAD motor (Figure).