Implantable cardiac defibrillator leads dysfunction after LVAD implantation

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Implantable cardioverter-defibrillator (ICD) lead dysfunction is a known complication following left ventricular assist device (LVAD) implantation.
• Previous studies on this complication are limited and primarily from single-center investigations.

Purpose of the Study:

• To describe and characterize the incidence of ICD lead parameter dysfunction after LVAD implantation.
• To assess the clinical significance of these lead parameter changes.

Main Methods:

• Analysis of ICD interrogation data from patients who had an ICD prior to LVAD implantation (n=401).
• Defined lead dysfunction as >50% decrease in sensing, >100Ω change in pacing impedance, or >50% increase in pacing threshold.
• Included 122 patients with available pre- and post-LVAD ICD interrogation reports.

Main Results:

• 55% (67/122) of patients experienced at least one significant lead dysfunction post-LVAD.
• Specific dysfunctions included decreased sensing (15%), altered pacing impedance (42%), and increased pacing threshold (20%).
• All ventricular arrhythmias during follow-up were successfully managed by the ICD.

Conclusions:

• Over 50% of patients receiving an LVAD may experience significant changes in ICD lead parameters.
• Despite frequent lead parameter changes, no severe clinical consequences were observed.
• Lead dysfunctions were manageable conservatively.