Internal Medicine Department, University of Nevada, Las Vegas, Nevada, USA.
Cardiovascular Division, Mayo Clinic Rochester, Rochester, Minnesota, USA.
Pacing Clin Electrophysiol. 2021 Jul;44(7):1163-1175. doi: 10.1111/pace.14265. Epub 2021 May 21.
Many advanced heart failure patients have both a left ventricular assist device (LVAD) and an implantable cardioverter-defibrillator (ICD). This study examines incidence, clinical impact, and management of LVAD-related EMI.
We performed a three-center retrospective analysis of transvenous ICD implanted patients with LVAD implanted between January 1, 2005 and December 31, 2020. The primary outcome was EMI after LVAD implantation, categorized as LVAD-related noise or telemetry interference.
The rate of LVAD-related EMI among the 737 patients (mean age 58.6 ± 12.8 years) studied was 5.0%. Telemetry interference (1.5%) compromised ICD interrogation in all patients. This was resolved successfully with use of a metal shield, encased wand, radiofrequency tower, different ICD programmer or by increasing distance between ICD programmer and LVAD (n = 6). ICD replacement was required to reestablish successful communication in three patients. LVAD-related noise (3.5%) led to oversensing (n = 4), inappropriate mode switches (n = 4), noise reversion (n = 3), inhibition of pacing (n = 2), inappropriate detection as atrial fibrillation (AF) (n = 2) and inappropriate detection as ventricular tachycardia (VT) and/or ventricular fibrillation (VF) (n = 2). This noise interference persisted (n = 3), resolved spontaneously (n = 16), resolved with programming change (n = 6) or required lead revision (n = 1).
EMI from LVAD impacts ICD function, although, the incidence rate is low. Physicians implanting both, LVAD in patients with ICD (more common) or ICD in patients with LVAD, should be aware of possible interferences. Telemetry failure not resolved by metal shielding was overcome by ICD generator replacement to a different manufacturer. In most cases, LVAD-related noise resolves spontaneously.
许多晚期心力衰竭患者同时装有左心室辅助装置（LVAD）和植入式心脏复律除颤器（ICD）。本研究旨在探讨 LVAD 相关 EMI 的发生率、临床影响和管理方法。
我们对 2005 年 1 月 1 日至 2020 年 12 月 31 日期间在三个中心接受 LVAD 植入的经静脉 ICD 植入患者进行了回顾性分析。主要结局是 LVAD 植入后的 EMI，分为 LVAD 相关噪声或遥测干扰。
在 737 名患者（平均年龄 58.6 ± 12.8 岁）中，LVAD 相关 EMI 的发生率为 5.0%。遥测干扰（1.5%）导致所有患者 ICD 检测失败。通过使用金属屏蔽、包裹棒、射频塔、不同的 ICD 程控仪或增加 ICD 程控仪和 LVAD 之间的距离（n=6），成功解决了这个问题。在 3 名患者中，需要更换 ICD 才能重新建立成功的通讯。LVAD 相关噪声（3.5%）导致过感知（n=4）、不适当的模式转换（n=4）、噪声反转（n=3）、起搏抑制（n=2）、被错误识别为心房颤动（AF）（n=2）和被错误识别为室性心动过速（VT）和/或心室颤动（VF）（n=2）。这种噪声干扰持续存在（n=3）、自发缓解（n=16）、通过编程改变（n=6）或需要导线修正（n=1）解决。
LVAD 产生的 EMI 会影响 ICD 的功能，尽管发生率较低。植入 ICD 的患者（更常见）或植入 LVAD 的患者同时植入这两种设备的医生应该意识到可能存在干扰。金属屏蔽未能解决的遥测故障通过更换到不同制造商的 ICD 发生器得到了克服。在大多数情况下，LVAD 相关的噪声会自发缓解。
