Abstract
Background
There are limited data on management of cardiac implantable electronic devices (CIED) in patients with left ventricular assist devices (LVADs). These patients may be at elevated risk of complications after undergoing CIED procedures.
Purpose
In order to better understand these risks, we set out to describe and quantify the complications associated with CIED procedures among patients with LVADs.
Methods
We retrospectively evaluated all patients with LVADs at our institution (n=235) from August 2007 to November 2017 who had any subsequent CIED procedure (initial implant, generator exchange, lead revision or extraction). We identified device-related complications at 30 days and one year from the time of the CIED procedure. Complications were defined as death, stroke, cardiac perforation, pericardial effusion, pneumothorax, lead dislodgment, infection, and any hematoma requiring a direct physician encounter.
Results
Forty-eight CIED interventions were performed on 42 patients after LVAD implant. Mean age was 49.4±15.1 years and 64% were male. Mean duration of LVAD therapy prior to procedure was 396 days. All patients were on warfarin therapy (mean INR 2.33±0.68); in 83% of procedures patients were on at least one anti-platelet agent. All interventions involved placement or revision of an ICD system. Fourteen procedures (29%) were initial implants and 34 (71%) were secondary procedures (19 generator exchanges, 13 lead revisions ± generator exchange and 2 extractions). Seven procedures (14.5%) were complicated by pocket hematoma; all of these were in secondary procedures. Patients with hematomas trended toward higher INR (2.51±0.26 vs 2.31±0.72); this was not statistically significant. Two patients with hematoma developed CIED infection, resulting in a total infection rate of 4.2%. Of those, one developed systemic infection requiring extraction of the system and the other developed a pocket infection managed with pocket washout and prolonged antibiotics. All complications occurred within 30 days of the procedure (Figure 1).
Figure 1. Complication free survival
Conclusion
In this single center study, CIED procedures on patients with preexisting LVAD was associated with a low rate of complications requiring intervention.
Acknowledgement/Funding
Emory University
Management of Arrhythmias and Cardiac Implantable Electronic Devices in Patients With Left Ventricular Assist Devices
