ICD Therapy in LVAD: Rates and Predictors of Appropriate and Inappropriate Shock

Abstract

Purpose Ventricular arrhythmias (VA) are common in continuous flow-left ventricular assist devices (CF-LVAD) patients. We investigated the rates of appropriate and inappropriate implantable cardioverter defibrillator (ICD) discharges following CF-LVAD placement without planned ICD reprograming. Methods All patients with CF-LVAD and prior ICD implants from 2008-2018 with pre and post implant follow up data (n=82) were eligible. Appropriate ICD discharge was defined as shock received for VA as reported by an electrophysiologist, whereas shocks received for any other rhythms were considered inappropriate. Results 16 out of 82 patients received an appropriate ICD discharge whereas 6 received an inappropriate shock during follow up (mean 1.51 years). The rates of receiving appropriate shock for VA were 19.5% (0.129 per patient year), and for inappropriate shock were 7.3% (0.064 per patient year). We compared the baseline characteristics of patients who received an appropriate ICD shock to those without any shocks (Table). In a multivariate logistic model, after adjusting for several variables including atrial fibrillation, amiodarone use, NYHA class, and type of cardiomyopathy, only the history of pre-LVAD VA was associated with higher odds of post left ventricular assist device (LVAD) appropriate discharge (p=0.004). There were no baseline characteristics predictive of inappropriate ICD shock. Conclusion Patients with CF-LVAD and ICD have a high burden of appropriate and inappropriate ICD shocks. History of pre-LVAD VA predicted higher chances of appropriate ICD shock post LVAD. Prospective multicenter trials are necessary to investigate optimal ICD programing to safely reduce rates of appropriate and inappropriate therapy.