Inappropriate implantable cardioverter-defibrillator therapy due to electromagnetic interference in patient with a HeartWare HVAD left ventricular assist device

Abstract

Advances in implantable technology have led to innovating new features, increased durability and longevity, lower risks of complications, and miniaturization. Such has been the case with implantable cardioverter-defibrillators (ICDs) and left ventricular assist devices (LVADs) over the last decade, resulting in their increased use and patient acceptance. 1 Lindenfeld J. Feldman A.M. Saxon L. et al. Effects of cardiac resynchronization therapy with or without a defibrillator on survival and hospitalizations in patients with New York Heart Association class IV heart failure. Circulation. 2007; 115: 204-212 Crossref PubMed Scopus (171) Google Scholar , 2 Pagani F.D. Miller L.W. Russell S.D. et al. Extended mechanical circulatory support with a continuous-flow rotary left ventricular assist device. J Am Coll Cardiol. 2009; 54: 312-321 Abstract Full Text Full Text PDF PubMed Scopus (722) Google Scholar In the face of substantial mortality associated with advanced heart failure and a diminishing pool of donor hearts, the number of patients managed with a combination of these life-saving devices as a bridge-to-transplant continues to grow. 2 Pagani F.D. Miller L.W. Russell S.D. et al. Extended mechanical circulatory support with a continuous-flow rotary left ventricular assist device. J Am Coll Cardiol. 2009; 54: 312-321 Abstract Full Text Full Text PDF PubMed Scopus (722) Google Scholar Recent clinical trials have shown pulsatile-flow LVADs improved survival compared with medical therapy in patients with contraindications to transplant, further expanding the LVAD's scope for use as destination or permanent therapy. 3 Rose E.A. Gelijns A.C. Moskowitz A.J. et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001; 345: 1435-1443 Crossref PubMed Scopus (3317) Google Scholar More recently, continuous-flow LVADs have shown superior outcomes compared with older pulsatile LVADs in this same destination therapy patient population. 4 Slaughter M.S. Rogers J.G. Milano C.A. et al. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009; 361: 2241-2251 Crossref PubMed Scopus (2393) Google Scholar The HeartWare HVAD LVAD (HeartWare, Inc, Framingham, MA, USA) is a miniaturized centrifugal pump that allows intrapericardial placement without the need for a preperitoneal abdominal LVAD pocket. 5 Wood C. Maiorana A. Larbalestier R. Lovett M. Green G. O'Driscoll G. First successful bridge to myocardial recovery with a HeartWare HVAD. J Heart Lung Transplant. 2008; 27: 695-697 Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar The impeller is suspended within the pump housing through a combination of passive magnets and hydrodynamic forces. The HeartWare HVAD currently is undergoing clinical trials in the United States as bridge-to-transplant therapy. To date, no formal studies have assessed the interaction of ICDs and LVADs. We report on the case of inappropriate ICD shock in a patient with this investigational, intrapericardially implanted, centrifugal-flow LVAD.