Effect of left ventricular assist device placement on preexisting implantable cardioverter-defibrillator leads.
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.


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.
Ambardekar
Amrut V
AV
Division of Cardiology and Cardiothoracic Surgery, University of Colorado Denver, Aurora, CO 80045, USA. Amrut.Ambardekar@ucdenver.edu
Lowery
Christopher M
CM
Allen
Larry A
LA
Cannon
Anne P
AP
Cleveland
Joseph C
JC
Lindenfeld
Joann
J
Brieke
Andreas
A
Sauer
William H
WH
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017147:Defibrillators, Implantable / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*