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Ineffective implantable cardioverter-defibrillator shocks among patients on continuous left ventricular assist device support: Clinical characteristics and management.

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Citation: Heart Rhythm O2. 1(5):336-340, 2020 Dec.PMID: 34113891Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Clinical Cardiac Electrophysiology | Clinical Cardiac Electrophysiology Fellowship | Internal Medicine ResidencyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2020 ISSN:

2666-5018

Name of journal: Heart rhythm O2Abstract: Background: Placement of a left ventricular assist device (LVAD) has been described to compromise implantable cardioverter-defibrillator (ICD) defibrillation threshold (DFT). Elevated DFT will have negative consequences and increases the risk of ineffective ICD shocks, morbidity, and mortality. DFT testing is not routinely performed in clinical practice, despite this fact.Conclusion: This case series highlights the need for a systematic approach to management of ICDs and DFT testing in LVAD patients. The addition of new shock vectors with azygos and subclavian coil implantation may reduce DFT, shock burden, morbidity, and mortality. Copyright (c) 2020 Heart Rhythm Society. Published by Elsevier Inc.Methods: Seven patients (5 male, mean age 52.2 +/- 9 years, 85.7% nonischemic cardiomyopathy) with an ICD in situ who progressed to NYHA class IV, ACC/AHA stage D chronic systolic congestive heart failure who underwent successful LVAD implantation presented to our institution in the setting of ventricular tachyarrhythmia and ineffective ICD shocks. Six patients underwent implantation of azygos and subclavian coils with subsequent DFT testing. The remaining patient was made comfort care.Objective: We describe the clinical characteristics of 7 LVAD patients who presented with multiple ineffective ICD shocks, along with the management strategy in such patients.Results: Five patients had successful DFT testing with azygos (n = 4) and subclavian (n = 1) defibrillation coil implantation. One patient had unsuccessful DFT testing despite evaluation of multiple shock vectors. There were no major or minor vascular complications in any of the cases. There were no procedural-related deaths.All authors: Brar V, Costello J, Hadadi C, O'Donoghue S, Shehadeh M, Worley SFiscal year: FY2021 Digital Object Identifier:

https://dx.doi.org/10.1016/j.hroo.2020.11.001

Date added to catalog: 2021-07-19

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Title notes ( 6 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	34113891	Available		34113891

Background: Placement of a left ventricular assist device (LVAD) has been described to compromise implantable cardioverter-defibrillator (ICD) defibrillation threshold (DFT). Elevated DFT will have negative consequences and increases the risk of ineffective ICD shocks, morbidity, and mortality. DFT testing is not routinely performed in clinical practice, despite this fact.

Conclusion: This case series highlights the need for a systematic approach to management of ICDs and DFT testing in LVAD patients. The addition of new shock vectors with azygos and subclavian coil implantation may reduce DFT, shock burden, morbidity, and mortality. Copyright (c) 2020 Heart Rhythm Society. Published by Elsevier Inc.

Methods: Seven patients (5 male, mean age 52.2 +/- 9 years, 85.7% nonischemic cardiomyopathy) with an ICD in situ who progressed to NYHA class IV, ACC/AHA stage D chronic systolic congestive heart failure who underwent successful LVAD implantation presented to our institution in the setting of ventricular tachyarrhythmia and ineffective ICD shocks. Six patients underwent implantation of azygos and subclavian coils with subsequent DFT testing. The remaining patient was made comfort care.

Objective: We describe the clinical characteristics of 7 LVAD patients who presented with multiple ineffective ICD shocks, along with the management strategy in such patients.

Results: Five patients had successful DFT testing with azygos (n = 4) and subclavian (n = 1) defibrillation coil implantation. One patient had unsuccessful DFT testing despite evaluation of multiple shock vectors. There were no major or minor vascular complications in any of the cases. There were no procedural-related deaths.

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