16-51: Evolution of ICD lead parameters after continuous-flow LVAD implantation

Abstract

Purpose of the study: Continuous‐flow left ventricular assist device (CF‐LVAD) is a treatment option for patients with end‐stage heart failure. Most of them have an implantable cardioverter defibrillator (ICD) to treat ventricular arrhythmias, and CF‐LVAD implantation may impair right ventricular (RV) lead parameters.We sought to evaluate RV lead characteristic changes after CF‐LVAD implantation. Method used: A multicenter analysis (6 institutions) of all ICD recipients implanted with a CF‐LVAD between 2008 and 2015 was retrospectively performed. Demographic data of the population and RV lead parameters pre‐and post‐CF‐LVAD were collected. Summary of the results: 61 patients (60.3 + 10.2 yo, 90.2% men) with CF‐LVAD and ICD were enrolled. Among them, 41 (67.2%) had a Heartmate 2, 15(24.6%) a Jarvik 2000, 3(4.9%) a Heartware and 2 Ventracor (3.3%). RV lead parameters were collected before and after a median time of 35.5 days post implantation. LVAD implantation was associated with a significant decrease in the RV signal amplitude and RV impedance (from 12.2 + 5.0 to 10.0 + 4.3 mV, p , 0.001, and from 541.7 + 182.7 to 446.4 + 119.0 ohms, p , 0.001, respectively). However, pacing threshold did not change (0.94 + 0.45 vs 0.90 + 0.53 V, p = 0.79). RV lead revision was not required in any of the patients included. Interferences between the ICD and the CF‐LVAD occurred in 5 patients, one of them requiring device replacement. Conclusions: In this multicenter study, CF‐LVAD implantation is associated with significant changes in RV lead parameters (sensing and impedance) of preexisting ICDs. However, none of the patients needed RV lead revision since ICD function was preserved (Figure Presented).