PO-04-075 TRANSVENOUS CARDIAC DEFIBRILLATOR WITHOUT INTERACTION WITH THE MAGNETIC TITANIUM BEADS SYSTEM FOR GASTROESOPHAGEAL REFLUX DISEASE

Abstract

Gastroesophageal reflux is increasingly treated with LINX®, a flexible bracelet of magnetic titanium beads (not MRI compatible) that is laparoscopically implanted to wrap around the gastroesophageal junction for providing tone/support aiding passive relaxation of a weak lower esophageal sphincter with peristalsis. The FDA currently cautions against concurrent use of the LINX® system with cardiac implantable electronic devices (CIEDs) given that the risk of electromagnetic interference (EMI) is unknown, and safety has not been established. We assessed the safety of a transvenous ICD in a patient with the LINX® system. Case Report 59 year old male who previously had the LINX® system implanted after hiatal hernia repair for refractory reflux. Shortly after, he was then diagnosed with apical hypertrophic cardiomyopathy with obstruction (NYHA Class I, genetic testing revealed VUS in CSRP3). Given non-sustained VT on cardiac event monitoring, family history of sudden cardiac death (SCD) and late gadolinium enhancement on cardiac magnetic resonance imaging with a calculated 5-year SCD risk 4.1%, he was recommended ICD implantation for primary prevention. Patient underwent an uneventful transvenous dual chamber defibrillator implantation. Although we do not routinely perform (DFT) testing at our institution, given the coexisting LINX® system in close proximity to the RV lead, we elected to proceed with DFT Testing, which was successful (1 induction: T-wave shock from sinus to VF, 30J delivered successfully to sinus with 7s charge time, no ATP, 70 ohms impedance). Patient underwent routine remote device interrogations and at 1-year follow up (which included an in-person device interrogation), continues to have normal lead parameters (sensing, impedance, threshold), minimal atrial or ventricular pacing, and no recurrent arrhythmias including NSVT (was started on verapamil). Specifically, patient received no inappropriate shocks, and no high frequency noise episodes were detected. We present the first case report of a patient who had a concomitant dual chamber ICD that was implanted shortly after a LINX device placement. We demonstrate normal DFTs at implant and no device interaction at 1 year follow-up, suggesting that ICD implantation without removal of the LINX device might be reasonable. Decision-making for cardiac device implantation decisions in such patients should consider additional theoretical risks until additional data with more patients is available.