CI-452769-3 INAPPROPRIATE ICD SHOCKS IN PATIENTS WITH LVADS: PREVALENCE, ASSOCIATED FACTORS, AND ETIOLOGIES

Abstract

Left Ventricular Assist Devices (LVADs) are increasingly used to treat advanced heart failure. While most patients with an LVAD have an implantable cardiac defibrillator (ICD) in situ, there are limited data on the frequency and causes of ICD therapies in patients with LVADs. To define the incidence, programming and patient characteristics associated with appropriate and inappropriate shocks in persons with ICDs and LVADs. We performed a retrospective review at Duke University Hospital of all LVAD recipients implanted with a HeartWare, HeartMate II, and HeartMate III (January 1, 2013 to June 30, 2019) and an ICD in situ. ICD shocks were adjudicated by the treating physician and a 2nd review for the purpose of this study. Among 437 patients with an ICD in situ undergoing LVAD implant, 147 (33.6%) patients had at least one shock episode following LVAD implantation. 12 patients were excluded due to incomplete device history. Among 135 patients, there were a total of 332 shock episodes: 257 (77.4%) appropriate and n=75 (22.6%) inappropriate. Etiologies for inappropriate shocks included SVT (n=66, 19.9%), physiologic oversensing (n=1, 0.3%), and non-physiologic oversensing (n=8, 2.4%). Overall, 92 (68.1%) patients had no inappropriate shock episodes, 43 (31.8%) patients had ≥ 1 inappropriate shock episodes, and 14 (10.4%) patients had ≥ 2 inappropriate shock episodes. Moreover, 26 (19.3%) patients had only inappropriate shock episodes. Among persons with inappropriate shocks, 0 of 47 patients had device programming consistent with consensus AHA recommendations (published after end of follow-up). The rate of inappropriate shocks in LVAD recipients is very high and is most often due to supraventricular arrhythmias. Implementation of current consensus AHA recommendations for LVAD programming may help avoid inappropriate shocks.