Allied Professionals (Non-physician submissions only) -> Teaching Case Reports D-AB18 - Quirks and Quarks from the EP Lab (ID 38) Abstract

D-AB18-01 - An Example Of Ventricular Assist Device Hardware Interfering With Leadless Pacemaker Implantation (ID 785)

 A. Schell: Nothing relevant to disclose.


Background: As leadless pacemakers (LPM) become more common, challenging scenarios will arise requiring providers to adapt the technology to suit patients with a variety of comorbid conditions.
Objective: To describe a challenging LPM implantation and the troubleshooting that resulted in a successful outcome.
Results: A 73-year-old patient had a left ventricular assist device (LVAD) implanted as destination therapy for end stage nonischemic cardiomyopathy, complicated by bacterial driveline infection and fungemia. He was hospitalized for a spontaneous right cerebellar hematoma. While hospitalized, he had periods of asymptomatic sinus arrest and AV block with pauses up to 4 seconds. Despite his lack of symptoms, his VAD flow rates were compromised. Given his frailty and infection risk, a LPM was considered a superior option when compared to a traditional transvenous PM. During LPM implantation at the right ventricular (RV) apex, the device was not able to be read by the programmer despite repositioning the programmer head. Fluoroscopic images showed the LPM to be directly posterior to the LVAD hardware. It was hypothesized that the LVAD hardware (centrifugal pump using magnetic levitation) was prohibiting the programmer head from reading the LPM. The LPM was removed and assessed with the programmer, which confirmed normal function. The LPM was then reinserted and implanted on the mid RV septum about 2 cm superior to the level of the LVAD in the LAO projection. Repeat testing established normal communication between the LPM and the programmer head.
Conclusion: LPM and LVAD can coexist if implanted with enough distance between the two to avoid PM programmer interference.