B-PO02-059 MULTICENTER ANALYSIS OF RIGHT VENTRICULAR LEAD DYSFUNCTION AFTER LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION: A COMPARISON OF CENTRIFUGAL-FLOW VS AXIAL-FLOW DEVICES

Abstract

Newer generation centrifugal-flow ventricular assist devices (CF-VAD) featuring a magnetically levitated disc are placed intrapericardially near the RV apex. Existing experience suggests an increased incidence of RV lead dysfunction following CF-VAD implantation, as compared axillary flow devices (AF-VAD) irrespective of concomitant valve surgery. To determine the incidence and potential mechanisms of RV lead malfunction following CF-VAD implantation. Retrospective analysis of all patients undergoing CF-VAD or AF-VAD placement between 1/2015 and 7/2020 at 2 centers. Peri-LVAD implant interrogation and post-implant CT scans were reviewed, and distances between the RV lead and VAD measured. RV lead dysfunction was defined as an increase in pacing threshold ≥ 2.0V. RV lead dysfunction following CF-VAD implantation occurred in 4.3% of AF-VAD patients (3 of 70) and 8.8% of CF-VAD patients (14 of 159). All patients demonstrating threshold change had their VAD implanted in one center, with an RV lead dysfunction incidence of 7.5% in AF-VAD vs 20% in CF-VAD (p=0.06). For CF-VAD patients with RV lead dysfunction, there was a significantly shorter lead-to-VAD housing distance (9.25 vs 21.1mm, P<0.01). However, there was no significant difference in distances between centers (20.3mm vs. 21.5mm, P=0.64). RV lead dysfunction is seen in a subset of patients undergoing VAD placement, and at higher rates with newer CF-VAD. Since the incidence of lead dysfunction varies both between centers and as a function of the lead-to-VAD housing distance, differences in surgical technique or RV lead placement may contribute to its occurrence.