Andreae Andrew, Black-Maier Eric, Arps Kelly, Kobe Elizabeth, Johnson Trevor, Shrader Peter, Holmes DaJuanicia, Towery Emily, Sun Albert, Friedman Daniel J, Koontz Jason, Schroder Jacob, Milano Carmelo, Khouri Michel G, Katz Jason N, Agarwal Richa, Russell Stuart D, Pokorney Sean, Daubert James, Piccini Jonathan
Division of Electrophysiology, Duke University Medical Center, Durham, North Carolina.
Division of Cardiology, Maine Medical Center, Portland, Maine.
Heart Rhythm. 2025 Feb;22(2):394-402. doi: 10.1016/j.hrthm.2024.07.099. Epub 2024 Jul 23.
Implantable cardioverter-defibrillator (ICD) shocks are a common complication after left ventricular assist device (LVAD) implantation; however, data on their frequency and causes are limited.
The purpose of this study was to define the incidence, programming, patient characteristics, and factors associated with appropriate and inappropriate ICD shocks in persons with LVADs.
We performed a retrospective review at Duke University Hospital of all LVAD recipients implanted between January 1, 2013, to June 30, 2019, with a preexisting ICD. ICD shocks were adjudicated by the treating physician and a second reviewer for the purpose of this study.
Among 421 patients with an ICD in situ undergoing LVAD implant, 147 (33.9%) had at least 1 shock after LVAD implantation. Among 134 patients with complete device history, a total of 330 shock episodes occurred: 255 (77.3%) appropriate and 75 (22.7%) inappropriate. Etiologies for inappropriate shocks included supraventricular tachycardia (n = 66 [20.0%]), physiological oversensing (n = 1 [0.3%]), and nonphysiological oversensing (n = 8 [2.4%]) including LVAD electromagnetic interference (n = 1 [0.3%]). ICD programming with shorter detection delay (P <.001) and absence of antitachycardia pacing programming (P = .001) in high-rate zones was seen more commonly in inappropriate shock than appropriate shock.
The rate of inappropriate shocks in LVAD recipients is very high and most often is due to supraventricular arrhythmias. LVAD electromagnetic interference is a rare cause of ICD shock. Implementation of current consensus American Heart Association recommendations for LVAD programming with long detection delays and high rate cutoffs may help prevent inappropriate ICD shocks.
植入式心脏复律除颤器（ICD）电击是左心室辅助装置（LVAD）植入术后的常见并发症；然而，关于其发生率和原因的数据有限。
本研究的目的是确定LVAD患者中适当和不适当ICD电击的发生率、程控、患者特征以及相关因素。
我们对2013年1月1日至2019年6月30日期间在杜克大学医院植入LVAD且术前已植入ICD的所有患者进行了回顾性研究。为了本研究的目的，ICD电击由主治医生和另一位审阅者进行判定。
在421例原位植入ICD并接受LVAD植入的患者中，147例（33.9%）在LVAD植入后至少发生1次电击。在134例有完整装置病史的患者中，共发生330次电击事件：255次（77.3%）为适当电击，75次（22.7%）为不适当电击。不适当电击的病因包括室上性心动过速（n = 66 [20.0%]）、生理性感知过度（n = 1 [0.3%]）和非生理性感知过度（n = 8 [2.4%]），包括LVAD电磁干扰（n = 1 [0.3%]）。与适当电击相比，不适当电击更常见的情况是在高心率区ICD程控的检测延迟较短（P <.001）且无抗心动过速起搏程控（P =.001）。
LVAD接受者中不适当电击的发生率非常高，且最常见的原因是室上性心律失常。LVAD电磁干扰是ICD电击的罕见原因。实施美国心脏协会当前关于LVAD程控的共识建议，采用长检测延迟和高心率阈值，可能有助于预防不适当的ICD电击。
