Cardiovascular Implantable Electronic Devices -> Bradycardia Devices: -> Device Technology D-PO02 - Poster Session II (ID 47) Poster

D-PO02-103 - Leadless Pacemaker Implantation In A Patient With A Left Ventricular Assist Device: Is It Really Contraindicated? (ID 205)

Abstract

Background: Patients with surgical left ventricular assist devices (LVAD) may develop an indication for chronic ventricular pacing but remain at an exaggerated risk for acute and chronic complications related to transvenous pacing leads. Leadless pacemakers are an attractive alternative to transvenous pacing systems but have not been studied in patients with LVADs. In fact, in the clinical trials, a pre-existing LVAD was a contraindication for LP implantation due to concerns for electromagnetic interference (EMI).
Objective: To demonstrate the feasibility of leadless pacemaker implantation in a patient with an LVAD.
Results: A 72 year old male with end-stage HCM, persistent AF and complete heart block, with an existing BiV ICD underwent LVAD implantation (Heartmate 3). Following LVAD implantation, it was noted that the RV lead was no longer capturing at high output, and he was maintained on epicardial pacing wires. Due to axillary venous occlusion, we opted to perform a leadless pacemaker implant for ventricular pacing support. The LP was positioned in the mid-basal RV septum to minimize the possibility of interference from the LVAD cannula in the apex (Figure). The pacing threshold (0.63 V @ 0.2 ms) and impedance (580 ohms) were within normal limits. At implant and 1 month post-implant the parameters remained within normal limits, and there was no evidence of EMI or other device-device interactions.
Conclusion: To our knowledge, this case represents the first report of a leadless pacemaker implantation in a patient with an existing LVAD. Further study is needed to confirm the safety and efficacy of this approach.
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