Implantable cardioverter-defibrillator–related procedures and associated complications in continuous flow left ventricular assist device recipients: A multicenter experience

• Published in: Heart rhythm O2 2021-12, Vol.2 (6), p.691-697
• Main Authors: Ravichandran, Ashwin, Pothineni, Naga Venkata K., Trivedi, Jaimin R., Roukoz, Henri, Ahmed, Mustafa M., Bhan, Adarsh, Bhat, Geetha, Cowger, Jennifer, Al Ahmad, Amin, Natale, Andrea, Di Biase, Luigi, Slaughter, Mark S., Lakkireddy, Dhanunjaya, Gopinathannair, Rakesh
• Format: Article
• Language: English
• Subjects: Cardiac implantable electronic device; Generator change; Heart failure; ICD; Implantable Devices; Left ventricular assist device; Procedures
• ISSN: 2666-5018; 2666-5018
• DOI: 10.1016/j.hroo.2021.09.005

Limited data exist regarding complication rates of implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy devices (CRT-D) in patients with left ventricular assist devices (LVAD). We describe the incidence and characteristics of ICD- and CRT-D-related procedures and complications in a multicenter LVAD cohort. A total of 537 LVAD patients with a pre-existing ICD or CRT-D from 5 centers were included. Details on device type, device therapies, procedural complications, and long-term survival were analyzed. Of 537 patients, 280 had a CRT-D and 257 had ICD only. During a median follow-up of 538 days, 126 patients underwent generator replacement with significantly higher rate in the CRT group (79 [28.2%] vs 47 [18.3%], P = .0006). Device-related complications occurred in 36 (13%) CRT-D and 20 (8%) ICD patients (P = .06). Incidence of pocket hematoma (3.2% vs 2.7%), infection (4.3% vs 1.6%), and lead malfunction (3.1% vs 2.8%) was similar in both groups, with no effect of device complication on long-term survival (log-rank P = .7). There was a higher incidence of post-LVAD antitachycardia pacing for ventricular arrhythmias in the CRT-D group compared to the ICD group (35% vs 26%, P = .03). Cardiac implantable electronic device–related procedures are common in LVAD patients. Compared to ICD only, continued CRT-D therapy post-LVAD results in a significantly higher number of generator changes and a trend towards higher device- or lead-related complications. Device-related complications were not associated with reduced survival.