Effect of Left Ventricular Assist Device Placement on Preexisting Implantable Cardioverter-defibrillator Leads

• Published in: Journal of cardiac failure 2010-04, Vol.16 (4), p.327-331
• Main Authors: Ambardekar, Amrut V., MD, Lowery, Christopher M., MD, Allen, Larry A., MD, MHS, Cannon, Anne P., BS, Cleveland, Joseph C., MD, Lindenfeld, Joann, MD, Brieke, Andreas, MD, Sauer, William H., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cardiovascular; Cohort Studies; Defibrillators, Implantable - standards; Female; Follow-Up Studies; heart failure; Heart-Assist Devices - standards; Humans; Male; Mechanical assist devices; Middle Aged; pacemaker; Retrospective Studies; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Left - surgery; Ventricular Dysfunction, Left - therapy
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2009.12.003

Abstract Background The left ventricular assist device (LVAD) is a therapy for patients with end-stage heart failure, many of whom have a preexisting implantable cardioverter-defibrillator (ICD). We investigated whether the implantation of a LVAD affects ICD function. Methods and Results Patients implanted with a LVAD between September 2000 and February 2009 were studied. Right ventricular (RV), right atrial, and left ventricular lead impedance, sensing, and capture thresholds were recorded before and after LVAD placement and subsequent lead-related interventions were noted. Of the 61 patients receiving a LVAD, data were collected from 30 patients who had preexisting ICDs. Significant pre-post differences were noted for all RV lead parameters: sensing amplitude decreased from 9.2 ± 3.1 to 5.7 ± 3.6 millivolts ( P < .001); impedance decreased from 479 ± 118 to 418 ± 94 ohms ( P = .008); and threshold increased from 4.3 ± 6.7 to 11.0 ± 16.8 microjoules ( P = .021). As a result of alterations in lead parameters, 4 patients (13%) required lead revisions and 6 patients (20%) required ICD testing. Conclusions Differences in ICD lead function were observed after LVAD placement resulting in clinically significant interventions. These data suggest that ICD interrogation be performed post-LVAD placement and that patients be counseled for the potential need for lead revisions and ICD testing when consented for a LVAD.