Abstract
The occurrence of noise and oversensing after implantation of a left ventricular assist device (LVAD) in patients with a pre-existing subcutaneous implantable cardioverter defibrillator (S-ICD) is not well-studied. To investigate the incidence of and factors associated with noise and oversensing in patients with S-ICD following LVAD implantation. A retrospective analysis was performed of patients implanted with LVAD from 2005 to 2020 at three Mayo Clinic centers in Minnesota, Arizona, and Florida. Patients with concomitant S-ICD and LVAD were identified. There were 9 patients with S-ICD who received LVAD (mean age 49.1 ± 13.7 years, 66.7% males). All patients had Boston Scientific second generation EMBLEM MRI S-ICDs. LVAD types included HeartMate II, HeartMate 3, and HeartWare in 11%, 44%, and 44% of the patients, respectively. The rate of noise and oversensing was 56% (5 out of 9). Three patients had noise from LVAD-related electromagnetic interference (EMI) which ultimately required ICD therapies to be turned off. Two patients had T-wave oversensing (TWOS) which resulted in inappropriate ICD shock. The SMART Pass feature resolved TWOS in one patient. All patients with HeartMate 3 and S-ICD had noise or oversensing. Multiple measures were unsuccessful in resolving the noise events, including utilizing the alternate sensing vector of the S-ICD, adjusting the time zone of the S-ICD, and increasing the LVAD pump speed. LVAD-related noise secondary to EMI and TWOS may be a common issue after LVAD implantation in patients with S-ICD.Tabled 1Noise and sensing issues in patients with subcutaneous ICD after LVAD implantationPatientLVADS-ICDNoise onset after LVAD implantation (days)Noise or Sensing issueInappropriate ICD shock(s)Management1.HM 3A219 EMBLEM MRI1Noise in all vectorsNoICD therapies OFF2.HM 3A209 EMBLEM MRI13Noise in all vectorsNoICD therapies OFF3.HM 3A219 EMBLEM MRI56Noise in all vectorsNoICD therapies OFF4.HM 3A219 EMBLEM MRI15T wave oversensingYes (once)Turning on SMART-Pass feature resolved oversensing5.HWA219 EMBLEM MRI9T wave oversensingYes (twice)ICD therapies OFF Open table in a new tab
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