CHU Rennes, INSERM, University of Rennes, Rennes, France.
Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, Lille, France.
Pacing Clin Electrophysiol. 2020 Nov;43(11):1309-1317. doi: 10.1111/pace.14004. Epub 2020 Jul 24.
Implantable cardioverter-defibrillator (ICD) lead dysfunction has been reported after left ventricular assist device (LVAD) implantation in limited single-center studies. We aimed at describing and characterizing the incidence of ICD lead parameters dysfunction after LVAD implantation.
Among the 652 patients enrolled in the ASSIST-ICD study, only patients with an ICD prior to LVAD were included (n = 401). ICD lead parameters dysfunction following LVAD implantation is defined as follows: (a) >50% decrease in sensing threshold, (b) pacing lead impedance increase/decrease by >100Ω, and (c) >50% increase in pacing threshold.
One hundred twenty-two patients with an ICD prior to LVAD had available ICD interrogation reports prior and after LVAD. A total of 67 (55%) patients exhibited at least one significant lead dysfunction: 17 (15%) exhibited >50% decrease in right ventricular (RV) sensing, 51 (42%) had >100 Ω increase/decrease in RV pacing impedance, and 24 (20%) experienced >50% increase in RV pacing threshold. A total of 52 patients experienced ventricular arrhythmia during follow-up and all were successfully detected and treated by the device. All lead dysfunction could be managed conservatively.
More than 50% of LVAD-recipients may experience >1 significant change in lead parameters but none had severe clinical consequences.
在有限的单中心研究中，报道了左心室辅助装置（LVAD）植入后植入式心脏复律除颤器（ICD）导线功能障碍。我们旨在描述和特征化 LVAD 植入后 ICD 导线参数功能障碍的发生率。
在 ASSIST-ICD 研究中纳入的 652 例患者中，仅纳入了在 LVAD 之前就有 ICD 的患者（n=401）。LVAD 植入后 ICD 导线参数功能障碍定义为：（a）感知阈值降低>50%，（b）起搏导线阻抗增加/减少>100Ω，和（c）起搏阈值增加>50%。
在 LVAD 之前就有 ICD 的 122 例患者有 LVAD 之前和之后的 ICD 检测报告。共有 67 例（55%）患者出现至少一项显著的导线功能障碍：17 例（15%）出现右心室（RV）感知降低>50%，51 例（42%）RV 起搏阻抗增加/减少>100 Ω，24 例（20%）RV 起搏阈值增加>50%。共有 52 例患者在随访期间发生室性心律失常，所有患者均被设备成功检测和治疗。所有导线功能障碍都可以保守治疗。
超过 50%的 LVAD 接受者可能会出现>1 项导线参数的显著变化，但没有任何患者出现严重的临床后果。
