Subcutaneous implantable cardioverter-defibrillator troubleshooting in patients with left ventricular assist devices: a case series and systematic review

Abstract Background There are limited data on the performance of the subcutaneous implantable cardioverter defibrillator (S-ICD) in patients with left ventricular assist devices (LVADs). Objective To describe the clinical course and outcomes of patients with both S-ICD and LVAD devices at our institution and via a systematic review of published studies. Methods We performed a retrospective cohort study of all patients who underwent LVAD implantation from 2009 to 2019 at Duke University Hospital. We also performed a systematic review of studies involving patients with an S-ICD and LVAD using the PUBMED/EMBASE databases. Results Among 588 patients undergoing LVAD implant with a pre-existing ICD, 4 had an S-ICD in situ following LVAD implantation. All 4 patients developed EMI in the primary/secondary vectors following LVAD implant, resulting in inappropriate ICD shocks in 2 patients. Sensing in the alternate vector was adequate immediately post-operatively in 1 patient. Post-operative undersensing was present in the alternate vector in 3 patients, but improved at first outpatient follow up in 2 patients, allowing tachy-therapies to be re-enabled. Eight studies involving 27 patients were identified in systematic review. EMI was common and frequently absent in the alternate vector (6 of 7 patients). Conclusions Undersensing and electromagnetic interference (EMI) are common after LVAD implantation in patients with a S-ICD in situ, particularly in the primary and secondary sensing vectors. Undersensing, in the alternate vector, may improve during follow up, obviating the need for device revision or extraction.