Cardiovascular Implantable Electronic Device Surgery Following Left Ventricular Assist Device Implantation

This study sought to determine the indications, characteristics, and outcomes of cardiovascular implantable electronic device (CIED) surgery in patients with LVAD. Many patients with a left ventricular assist device (LVAD) will require implantable cardioverter-defibrillator generator change or devic...

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Bibliographic Details
Published in:JACC. Clinical electrophysiology 2020-09, Vol.6 (9), p.1131-1139
Main Authors: Black-Maier, Eric, Lewis, Robert K., Loungani, Rahul, Rehorn, Michael, Friedman, Daniel J., Bishawi, Muath, Schroder, Jacob N., Milano, Carmelo A., Katz, Jason N., Patel, Chetan B., Rogers, Joseph G., Hegland, Donald D., Jackson, Kevin P., Frazier-Mills, Camille, Pokorney, Sean D., Daubert, James P., Piccini, Jonathan P.
Format: Article
Language:English
Subjects:
Arrhythmias, Cardiac - epidemiology
Arrhythmias, Cardiac - therapy
Defibrillators, Implantable - adverse effects
Electronics
Heart-Assist Devices - adverse effects
Humans
implantable cardioverter defibrillator
infection
left ventricular assist device
pocket hematoma
Retrospective Studies
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Summary:This study sought to determine the indications, characteristics, and outcomes of cardiovascular implantable electronic device (CIED) surgery in patients with LVAD. Many patients with a left ventricular assist device (LVAD) will require implantable cardioverter-defibrillator generator change or device revision or are candidates for de novo implantable cardioverter-defibrillator implantation following LVAD implantation. We performed an observational retrospective study of all LVAD recipients who subsequently underwent CIED surgery at Duke University Hospital from 2009 to 2019. A total of 159 patients underwent CIED surgery following LVAD implantation, including generator change (n = 93), device revision (n = 38), and de novo implant (n = 28). The median (interquartile range) time from LVAD implantation to CIED surgery was 18.1 months (5.5 to 35.1 months). Pre-operative risk for infection was elevated in the overall cohort with a median (interquartile range) Prevention of Arrhythmia Device Infection Trial (PADIT) score of 7.0 (5.0 to 9.0). Pocket hematoma occurred in 21 patients (13.2%) following CIED surgery. Antimicrobial envelops were used in 43 patients (27%). Device infection due to CIED surgery occurred in 5 (3.1%) patients and occurred only in patients who developed post-operative pocket hematoma (p 
ISSN:2405-500X
2405-5018
DOI:10.1016/j.jacep.2020.04.030