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Soni B, Gopinathannair R. Managing ventricular arrhythmias and implantable cardiac defibrillator shocks after left ventricular assist device implantation. J Cardiovasc Electrophysiol 2024; 35:592-600. [PMID: 38013210 DOI: 10.1111/jce.16142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
Continuous flow left ventricular assist devices (CF-LVADs) have been shown to reduce mortality and morbidity in patients with advanced heart failure with reduced ejection fraction. However, ventricular arrhythmias (VA) are common, are mostly secondary to underlying myocardial scar, and have a higher incidence in patients with pre-LVAD VA. Sustained VA is well tolerated in the LVAD patient but can result in implantable defibrillator (ICD) shocks, right ventricular failure, hospitalizations, and reduced quality of life. There is limited data regarding best practices for the medical management of VA as well as the role for procedural interventions in patients with uncontrolled VA and/or ICD shocks. Vast majority of CF-LVAD patients have a preexisting cardiovascular implantable electronic device (CIED) and ICD and/or cardiac resynchronization therapies are continued in many. Several questions, however, remain regarding the efficacy of ICD and CRT following CF-LVAD. Moreover, optimal CIED programming after CF-LVAD implantation. Therefore, the primary objective of this review article is to provide the most up-to-date evidence and to provide guidance on the clinical significance, pathogenesis, predictors, and management strategies for VA and ICD therapies in the CF-LVAD population. We also discuss knowledge gaps as well as areas for future research.
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Affiliation(s)
- Bosky Soni
- Department of Medicine, University of Pittsburgh School of Medicine, Harrisburg, Pennsylvania, USA
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2
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Takahari K, Oka T, Sekihara T, Ozu K, Akazawa Y, Nakamura D, Mizote I, Ohtani T, Hikoso S, Sakata Y. First Report of Electromagnetic Interference Between Percutaneous Ventricular Assist Device and Implantable Cardioverter-Defibrillator. JACC Case Rep 2023; 21:101981. [PMID: 37719285 PMCID: PMC10500352 DOI: 10.1016/j.jaccas.2023.101981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 09/19/2023]
Abstract
Electromagnetic interference (EMI) between implantable left ventricular assist devices and cardiac implantable electronic devices has been observed. We demonstrated the first case of EMI between a percutaneous ventricular assist device and an implantable cardioverter-defibrillator, validated by an extra vivo simulation test. EMI might depend on the distance between devices. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Kosuke Takahari
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takafumi Oka
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takayuki Sekihara
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kentaro Ozu
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasuhiro Akazawa
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Daisuke Nakamura
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Isamu Mizote
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Tanawuttiwat T, Das MK, Miller JM, Guglin ME. Device-device interaction between cardiac implantable electronic devices and continuous-flow left ventricular assist devices. Heart Rhythm 2023; 20:918-926. [PMID: 36863637 DOI: 10.1016/j.hrthm.2023.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 03/04/2023]
Abstract
The current design of an innovative left ventricular assist device (LVAD) makes use of magnetic levitation technology, which enables the rotors of the device to be completely suspended by magnetic force, reducing friction and blood or plasma damage. However, this electromagnetic field can result in electromagnetic interference (EMI), which can interfere with proper functioning of another cardiac implantable electronic device (CIED) in its direct proximity. Approximately 80% of patients with an LVAD have a CIED, most frequently an implantable cardioverter-defibrillator (ICD). Several device-device interactions have been reported, including EMI-induced inappropriate shocks, inability to establish telemetry connection, EMI-induced premature battery depletion, undersensing by the device, and other CIED malfunctions. Unfortunately, additional procedures, including generator exchange, lead adjustment, and system extraction, are frequently required because of these interactions. In some circumstances, the additional procedure might be preventable or avoidable with appropriate solutions. In this article, we describe how EMI from the LVAD impacts the functionality of the CIED and provide possible management options, including manufacturer-specific information, for the current CIEDs (eg, transvenous and leadless pacemakers, transvenous and subcutaneous ICDs, and transvenous cardiac resynchronization therapy pacemakers and ICDs).
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Affiliation(s)
| | - Mithilesh K Das
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana
| | - John M Miller
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana
| | - Maya E Guglin
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana
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Chatta P, Grewal D, Ali S, Garg J, Mandapati R, Contractor T, Bhardwaj R. Electromagnetic interference induced ventricular tachycardia in left ventricular assist device. Pacing Clin Electrophysiol 2022; 45:1379-1382. [PMID: 35768884 DOI: 10.1111/pace.14558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/31/2022] [Accepted: 06/17/2022] [Indexed: 01/20/2023]
Abstract
Left ventricular assist devices (LVAD) have been increasingly utilized end-stage heart failure despite guidelinedirected medical therapy (due to limited organ availability) as a bridge to transplant or destination therapy, with improved overall survival.Majority of patients undergoing LVAD implantation have pre-existing implantable cardioverter-defibrillator (ICD) in-situ.We present a case of device-device interaction resulting in EMI inducing recurrent inappropriate device therapies inducing ventricular arrhythmia followed by the inappropriate triggering of noise reversion mode, thereby inhibiting device therapies.With the increase in number of end-stage heart failure patients with ICDs in situ (and limited organ availability) undergoing LVAD implantation, it is imperative to recognize potential device-device interactions to avoid unwarranted invasive interventions.
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Affiliation(s)
- Payush Chatta
- Division of Internal Medicine, Department of Medicine, Loma Linda University, Loma Linda, California, USA
| | - Dennis Grewal
- Division of Cardiology, Department of Internal Medicine, Loma Linda University, Loma Linda, California, USA
| | - Saif Ali
- Division of Cardiology, Department of Internal Medicine, Loma Linda University, Loma Linda, California, USA
| | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University, Loma Linda, California, USA
| | - Ravi Mandapati
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University, Loma Linda, California, USA
| | - Tahmeed Contractor
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University, Loma Linda, California, USA
| | - Rahul Bhardwaj
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University, Loma Linda, California, USA
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5
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Sheldon SH, Jazayeri MA, Pierpoline M, Mohammed M, Parikh V, Robinson A, Noheria A, Haglund N, Sauer AJ, Reddy YM. Electromagnetic interference from left ventricular assist devices detected in patients with implantable cardioverter-defibrillators. J Cardiovasc Electrophysiol 2021; 33:93-101. [PMID: 34837431 DOI: 10.1111/jce.15300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Electromagnetic interference (EMI) from left ventricular assist devices (LVADs) can cause implantable cardioverter-defibrillator (ICD) oversensing. We sought to assess the frequency of inappropriate shocks/oversensing due to LVAD-related EMI and prospectively compare integrated (IB) versus dedicated bipolar (DB) sensing in patients with LVADs. METHODS Single-center study in LVAD patients with Medtronic or Abbott ICDs between September 2017 and March 2020. We excluded patients that were pacemaker dependent. Measurements were obtained of IB and DB sensing and noise to calculate a signal-to-noise ratio (SNR). Device checks were reviewed to assess appropriate and inappropriate sensing events. RESULTS Forty patients (age 52 ± 14 years, 75% men, 38% ischemic cardiomyopathy) were included with the median time between LVAD implantation and enrollment of 6.7 months (2.3, 11.4 months). LVAD subtypes included: HeartWare (n = 22, 55%), Heartmate II (n = 10, 25%), and Heartmate III (n = 8, 20%). Over a follow-up duration of 21.6 ± 12.9 months after LVAD implantation, 5% of patients (n = 2) had oversensing of EMI from the LVAD (both with HeartWare LVADs and Abbott ICDs) at 4 days and 10.8 months after LVAD implantation. Both patients underwent adjustment of ventricular sensing with resolution of oversensing and no further events over 5 and 15 months of further follow-up. The SNR was similar between IB and DB sensing (50 [29-67] and 57 [41-69], p = 0.89). CONCLUSION ICD oversensing of EMI from LVADs is infrequent and can be managed with reprogramming the sensitivity. There was no significant difference in the R-wave SNR with IB versus DB ICD leads.
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Affiliation(s)
- Seth H Sheldon
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Mohammad-Ali Jazayeri
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Michael Pierpoline
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Moghniuddin Mohammed
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Valay Parikh
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Alexander Robinson
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Nicholas Haglund
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Andrew J Sauer
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Y Madhu Reddy
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
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Smietana J, Schell A, Pothineni NVK, Walsh K, Lin D. A left ventricular assist device interfering with leadless pacemaker implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1949-1951. [PMID: 34346519 DOI: 10.1111/pace.14332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/03/2021] [Accepted: 08/01/2021] [Indexed: 11/30/2022]
Abstract
Left ventricular assist devices (LVAD) produce electromagnetic interference (EMI) which can have implications when patients require cardiac implantable electronic devices. Leadless pacemakers have been successfully implanted in patients with Heartmate 2 and Heartmate 3 LVADs without evidence of EMI or device-to-device interaction. Here we report a case of a Heartmate 3 LVAD and Micra VR transcatheter pacing system interaction requiring device repositioning.
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Affiliation(s)
- Jeffrey Smietana
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrea Schell
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Naga Venkata K Pothineni
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katie Walsh
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Lin
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Khetarpal BK, Lee JZ, Javaid AI, Mi L, Venepally NR, Narasimhan B, Hardaway BW, Cha YM, Kusumoto F, Mulpuru SK, Srivathsan K. Electromagnetic interference from left ventricular assist device in patients with transvenous implantable cardioverter-defibrillator. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1163-1175. [PMID: 33977542 DOI: 10.1111/pace.14265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/03/2021] [Accepted: 05/09/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many advanced heart failure patients have both a left ventricular assist device (LVAD) and an implantable cardioverter-defibrillator (ICD). This study examines incidence, clinical impact, and management of LVAD-related EMI. METHODS We performed a three-center retrospective analysis of transvenous ICD implanted patients with LVAD implanted between January 1, 2005 and December 31, 2020. The primary outcome was EMI after LVAD implantation, categorized as LVAD-related noise or telemetry interference. RESULTS The rate of LVAD-related EMI among the 737 patients (mean age 58.6 ± 12.8 years) studied was 5.0%. Telemetry interference (1.5%) compromised ICD interrogation in all patients. This was resolved successfully with use of a metal shield, encased wand, radiofrequency tower, different ICD programmer or by increasing distance between ICD programmer and LVAD (n = 6). ICD replacement was required to reestablish successful communication in three patients. LVAD-related noise (3.5%) led to oversensing (n = 4), inappropriate mode switches (n = 4), noise reversion (n = 3), inhibition of pacing (n = 2), inappropriate detection as atrial fibrillation (AF) (n = 2) and inappropriate detection as ventricular tachycardia (VT) and/or ventricular fibrillation (VF) (n = 2). This noise interference persisted (n = 3), resolved spontaneously (n = 16), resolved with programming change (n = 6) or required lead revision (n = 1). CONCLUSIONS EMI from LVAD impacts ICD function, although, the incidence rate is low. Physicians implanting both, LVAD in patients with ICD (more common) or ICD in patients with LVAD, should be aware of possible interferences. Telemetry failure not resolved by metal shielding was overcome by ICD generator replacement to a different manufacturer. In most cases, LVAD-related noise resolves spontaneously.
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Affiliation(s)
| | - Justin Z Lee
- Cardiovascular Division, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Awad I Javaid
- Internal Medicine Department, University of Nevada, Las Vegas, Nevada, USA
| | - Lanyu Mi
- Cardiovascular Division, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Nithin Rao Venepally
- Internal Medicine Department, Texas Tech University Health Science Center, Texas, USA
| | - Bharat Narasimhan
- Internal Medicine Department, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Brian W Hardaway
- Cardiovascular Division, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Yong-Mei Cha
- Cardiovascular Division, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Fred Kusumoto
- Cardiovascular Division, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Siva K Mulpuru
- Cardiovascular Division, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Gordon JS, Maynes EJ, O'Malley TJ, Pavri BB, Tchantchaleishvili V. Electromagnetic interference between implantable cardiac devices and continuous-flow left ventricular assist devices: a review. J Interv Card Electrophysiol 2021; 61:1-10. [PMID: 33433742 DOI: 10.1007/s10840-020-00930-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/27/2020] [Indexed: 11/30/2022]
Abstract
Many patients with continuous-flow left ventricular assist devices (CF-LVAD) have other, co-existing implantable cardiac devices. While such devices often function appropriately, there is potential for electromagnetic interference (EMI). A literature review was performed to identify cases of EMI between CF-LVAD and other implanted cardiac devices to better understand their etiology, outcomes, and the strategies used to overcome such interference. The cases identified included interference between CF-LVAD and pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy. The EMI reported in the current literature can be broken down into two general categories: interference leading to difficulty establishing telemetry and interference leading to impaired electrical signal sensing. Such interference led to inappropriate shock delivery in some cases. The type of interference, and thus treatments, differed and were device dependent. The strategies employed to reduce interference included metal shielding, physical manipulation to increase the distance between devices, and even exchange of the implanted device with another brand of the same class. To avoid such EMI in the future, physicians must be aware of the reported interference between certain devices, and manufacturers must work more closely to increase the compatibility of implanted cardiac devices.
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Affiliation(s)
- Jonathan S Gordon
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, 1025 Walnut St, Suite 607, Philadelphia, PA, USA
| | - Elizabeth J Maynes
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, 1025 Walnut St, Suite 607, Philadelphia, PA, USA
| | - Thomas J O'Malley
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Behzad B Pavri
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Vakhtang Tchantchaleishvili
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, 1025 Walnut St, Suite 607, Philadelphia, PA, USA.
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Jin C, Hsu J, Frenkel D, Jacobson JT, Iwai S, Ferrick A. Unique technique to relieve left ventricular assist device electromagnetic interference with an implantable cardioverter defibrillator. J Cardiovasc Electrophysiol 2021; 32:551-553. [PMID: 33345375 DOI: 10.1111/jce.14840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 11/30/2022]
Abstract
We introduced a simple technique to eliminate electromagnetic interference between a left ventricular assist device (LVAD) and an implantable cardioverter defibrillator (ICD). A 43-year-old male with heart failure and a reduced ejection fraction who had an ICD presented with decompensated heart failure and received an LVAD as a bridge to transplant. Remote monitoring showed persistent atrial fibrillation causing an inappropriate ICD shock leading to a decision to disable shock therapies. However, an in-office interrogation was unsuccessful due to electromagnetic interference. Patient was instructed to extend his arm above his head on the ipsilateral side of the ICD, thus increasing the distance between LVAD and ICD, eliminating the interaction to allow reprogramming of the device.
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Affiliation(s)
- Chengyue Jin
- Department of Medicine, Westchester Medical Center, Valhalla, New York, USA
| | - Joshua Hsu
- New York Medical College, Valhalla, New York, USA
| | - Daniel Frenkel
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Jason T Jacobson
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Sei Iwai
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Aileen Ferrick
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
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Burri H. Cardiovascular Implantable Electronic Device Procedures in Patients With Left Ventricular Assist Devices: Balancing Risks With Benefit. JACC Clin Electrophysiol 2020; 6:1140-1143. [PMID: 32972549 DOI: 10.1016/j.jacep.2020.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland.
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Rehorn MR, Koontz J, Barnett AS, Black-Maier E, Piccini JP, Loring Z, Schroder J, Sun AY. Noninvasive electrocardiographic mapping of ventricular tachycardia in a patient with a left ventricular assist device. HeartRhythm Case Rep 2020; 6:398-401. [PMID: 32695586 PMCID: PMC7361129 DOI: 10.1016/j.hrcr.2020.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Michael R. Rehorn
- Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
- Address reprint requests and correspondence: Dr Michael R. Rehorn, Box 3154-Cardiac Electrophysiology, Duke University Medical Center, Durham, NC 27710.
| | - Jason Koontz
- Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
- Durham VA Medical Center, Durham, North Carolina
| | - Adam S. Barnett
- Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
| | - Eric Black-Maier
- Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
| | - Jonathan P. Piccini
- Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
| | - Zak Loring
- Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
| | - Jacob Schroder
- Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
- Durham VA Medical Center, Durham, North Carolina
| | - Albert Y. Sun
- Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
- Durham VA Medical Center, Durham, North Carolina
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12
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Ishida Y, Payne JE, Field ME, Gold MR. Electromagnetic interference from left ventricular assist devices in patients with subcutaneous implantable cardioverter-defibrillators. J Cardiovasc Electrophysiol 2020; 31:1195-1201. [PMID: 32128931 DOI: 10.1111/jce.14431] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/07/2020] [Accepted: 02/19/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Interactions of left ventricular assist devices (LVADs) with transvenous implantable cardioverter-defibrillator systems (ICDs) have been widely reported. However, less is known regarding the impact of electromagnetic interference (EMI) from LVADs on subcutaneous ICD function. METHODS AND RESULTS A comprehensive literature search was performed on PubMed, Cochrane central registry, and Google Scholar using the search terms "subcutaneous implantable cardioverter-defibrillator and left ventricular assist devices," "electromagnetic interference, LVAD, and subcutaneous ICD," "EMI and S-ICD," and "inappropriate shocks, LVAD, and ICD." Demographic and programming data were extracted from the reports and authors as needed. A total of seven cases of EMI in LVAD patients with subcutaneous ICD (S-ICD) devices were found. In addition three previously unreported cases from our center were included. All cases involved either a heartware ventricular assist device or HeartMate III LVAD with a pre-existing S-ICD. In all patients, both the primary and secondary vectors had inappropriate sensing due to EMI. Three patients were reprogramed to the alternate vector with appropriate sensing. The S-ICD was either inactivated or replaced with a transvenous device in six patients. A single patient was left sensing in the alternate vector. There were no reports of inability to interrogate S-ICD systems in patients with LVADs. CONCLUSION The risk of inappropriate shocks from LVADs should be considered in pre-existing patients with S-ICD, particularly when the heartware ventricular assist device or HeartMate III LVAD device is present. Reprogramming of the sensing vector can occasionally avoid this issue but often the S-ICD needs to be inactivated.
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Affiliation(s)
- Yuji Ishida
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.,Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Joshua E Payne
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Michael E Field
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
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Boulet J, Massie E, Mondésert B, Lamarche Y, Carrier M, Ducharme A. Current Review of Implantable Cardioverter Defibrillator Use in Patients With Left Ventricular Assist Device. Curr Heart Fail Rep 2019; 16:229-239. [DOI: 10.1007/s11897-019-00449-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Schukro C, Schlöglhofer T, Khazen C, Röhrich M, Laufer G, Zimpfer D, Wiedemann D. Influence of a fully magnetically levitated left ventricular assist device on functional interrogation of implantable cardioverter defibrillators. Clin Cardiol 2019; 42:914-918. [PMID: 31282021 PMCID: PMC6788470 DOI: 10.1002/clc.23228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/28/2019] [Indexed: 11/17/2022] Open
Abstract
Background Electromagnetic interference between left ventricular assist devices (LVAD) and the telemetry wand of implantable cardioverter‐defibrillators (ICD) with impairment of ICD interrogation has previously been described in HVAD and HeartMate II devices. This is the first study showing the potential influence of the LVAD model HeartMate 3 (with the unique feature of fully magnetically levitated rotor with consistent wide blood‐flow gaps) on functional interrogation of different ICD models. Methods and Results Among 51 patients treated with a HeartMate 3 LVAD, 34 patients (66.7%) already had an ICD implanted prior to LVAD therapy. In this cohort, impairment of ICD interrogation was observed in five patients (14.7%) with five different device models. In patients with Biotronik ICD, stretching of the ipsilateral arm to increase the distance between both devices >10 cm was sufficient in one patients, whereas surgical contralateral repositioning was necessary in two patients; in one further patient no action could be taken, as he died early from embolic stroke. In the only patient with a MicroPort ICD, this issue was resolved by using a wireless telemetry. The distances between both devices showed no statistical significant correlation with an impaired interrogation, neither in the overall collective nor within the groups with the same manufacturer. Conclusions In patients with impaired ICD interrogation caused by electromagnetic interference between a HeartMate 3 LVAD and the ICD, the actions mentioned above have to be taken, to resolve this technical issue. Especially, a sufficient distance of at least 10 cm between both devices was crucial for avoiding this problem.
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Affiliation(s)
- Christoph Schukro
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Thomas Schlöglhofer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.,Ludwig-Boltzmann-Cluster for Cardiovascular Research, Vienna, Austria
| | - Cesar Khazen
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael Röhrich
- Department of Anesthesia, Intensive Care Medicine and Pain Therapy, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik Wiedemann
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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15
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Electromagnetic Interference from Left Ventricular Assist Device (LVAD) Inhibiting the Pacing Function of an Implantable Cardioverter-Defibrillator (ICD) Device. Case Rep Cardiol 2018; 2018:6195045. [PMID: 30402296 PMCID: PMC6192132 DOI: 10.1155/2018/6195045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/06/2018] [Indexed: 12/13/2022] Open
Abstract
There is an increasing prevalence of patients with concomitant implantable cardioverter-defibrillators (ICDs) and left ventricular devices (LVADs). The potential for negative interactions between these continually evolving technologies is a valid concern. Previously reported interactions include inappropriate ICD therapy and interference with ICD telemetry function. Understanding the nature of such interactions and developing a comprehensive strategy to approach such situations are important. In this report, we describe a case of electromagnetic interference from LVAD inhibiting the pacing function of an ICD that was corrected by reprograming the device. We would encourage investigators to review patients with ICD and LVAD in their institutions in order to help assess the frequency and nature of these and other interactions.
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16
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Parikh V, Sauer A, Friedman PA, Sheldon SH. Management of cardiac implantable electronic devices in the presence of left ventricular assist devices. Heart Rhythm 2018; 15:1089-1096. [DOI: 10.1016/j.hrthm.2018.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Indexed: 10/18/2022]
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17
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Sehatbakhsh S, Kushnir A, Kabach M, Kolek M, Chait R, Ghumman W. A case of electromagnetic interference between HeartMate 3 LVAD and implantable cardioverter defibrillator. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:218-220. [PMID: 28976004 DOI: 10.1111/pace.13210] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/12/2017] [Accepted: 09/22/2017] [Indexed: 12/14/2022]
Abstract
Implantable cardioverter defibrillators (ICDs) have been shown to have a significant benefit in reducing sudden cardiac death (SCD) in patients with systolic heart failure. Additionally, cardiac devices as a bridge to transplant or destination therapy are often used in patients with end-stage systolic heart failure. As a result, most patients with left ventricular assist devices (LVADs) also have an ICD. Here, we present an electromagnetic interference (EMI) between HeartMate 3 LVAD and ICD. This issue might be critical for both electrophysiologists and advanced heart failure cardiologists to understand prior to implantation of ICD/LVADs in these patients.
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18
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Murphy M, Welch T, Shaw PW, Kennedy JLW, Bilchick KC. Inhibition of pacing in a dependent patient with an implantable cardioverter-defibrillator and a left ventricular assist device. HeartRhythm Case Rep 2016; 2:473-477. [PMID: 28491740 PMCID: PMC5419973 DOI: 10.1016/j.hrcr.2016.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Michele Murphy
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Timothy Welch
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Peter W Shaw
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Jamie L W Kennedy
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Kenneth C Bilchick
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
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19
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Choi AJ, Thomas SS, Singh JP. Cardiac Resynchronization Therapy and Implantable Cardioverter Defibrillator Therapy in Advanced Heart Failure. Heart Fail Clin 2016; 12:423-36. [PMID: 27371518 DOI: 10.1016/j.hfc.2016.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Patients with advanced heart failure are at high risk for progression of their disease and sudden cardiac death. The role of device therapy in this patient population continues to evolve and is directed toward improving cardiac pump function and/or reducing sudden arrhythmic death.
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Affiliation(s)
- Anthony J Choi
- Electrophysiology Laboratory, Cardiac Arrhythmia Service, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Sunu S Thomas
- Heart Failure & Transplant Services, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Jagmeet P Singh
- Electrophysiology Laboratory, Cardiac Arrhythmia Service, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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20
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Raman AS, Shabari FR, Kar B, Loyalka P, Hariharan R. No Electromagnetic Interference Occurred in a Patient with a HeartMate II Left Ventricular Assist System and a Subcutaneous Implantable Cardioverter-Defibrillator. Tex Heart Inst J 2016; 43:183-5. [PMID: 27127441 DOI: 10.14503/thij-14-4795] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The use of subcutaneous implantable cardioverter-defibrillators is a novel option for preventing arrhythmia-mediated cardiac death in patients who are at risk of endovascular-device infection or in whom venous access is difficult. However, the potential for electromagnetic interference between subcutaneous defibrillators and left ventricular assist devices is largely unknown. We report the case of a 24-year-old man in whom we observed no electromagnetic interference between a subcutaneous implanted cardioverter-defibrillator and a HeartMate II Left Ventricular Assist System, at 3 different pump speeds. To our knowledge, this is the first report of such findings in this circumstance.
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21
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Hanke JS, Rojas SV, Avsar M, Bara C, Ismail I, Haverich A, Schmitto JD. HeartWare left ventricular assist device for the treatment of advanced heart failure. Future Cardiol 2016; 12:17-26. [DOI: 10.2217/fca.15.58] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The importance of mechanical circulatory support in the therapy of advanced heart failure is steadily growing. The rapid developments in the field of mechanical support are characterized by continuous miniaturization and enhanced performance of the assist devices, providing increased pump durability and prolonged patient survival. The HeartWare left ventricular assist device system (HeartWare Inc., Framingham, MA, USA) is a mechanical ventricular assist device with over 8000 implantations worldwide. Compared with other available assist devices it is smaller in size and used in a broad range of patients. The possibility of minimally invasive procedures is one of the major benefits of the device – allowing implants and explants, as well as exchanges of the device with reduced surgical impact. We present here a review of the existing literature on the treatment of advanced heart failure using the HeartWare left ventricular assist device system.
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Affiliation(s)
- Jasmin S Hanke
- Department of Cardiac, Thoracic, Transplantation & Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Sebastian V Rojas
- Department of Cardiac, Thoracic, Transplantation & Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiac, Thoracic, Transplantation & Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Bara
- Department of Cardiac, Thoracic, Transplantation & Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Issam Ismail
- Department of Cardiac, Thoracic, Transplantation & Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiac, Thoracic, Transplantation & Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiac, Thoracic, Transplantation & Vascular Surgery, Hannover Medical School, Hannover, Germany
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22
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Swerdlow CD, Asirvatham SJ, Ellenbogen KA, Friedman PA. Troubleshooting implanted cardioverter defibrillator sensing problems I. Circ Arrhythm Electrophysiol 2015; 7:1237-61. [PMID: 25516582 DOI: 10.1161/circep.114.002344] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Charles D Swerdlow
- From the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.); Division of Cardiology, Mayo Clinic, Rochester, MN (S.J.A., P.A.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.).
| | - Samuel J Asirvatham
- From the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.); Division of Cardiology, Mayo Clinic, Rochester, MN (S.J.A., P.A.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.)
| | - Kenneth A Ellenbogen
- From the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.); Division of Cardiology, Mayo Clinic, Rochester, MN (S.J.A., P.A.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.)
| | - Paul A Friedman
- From the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.); Division of Cardiology, Mayo Clinic, Rochester, MN (S.J.A., P.A.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.)
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23
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Sabashnikov A, Mohite PN, Simon AR, Popov AF. HeartWare miniaturized intrapericardial ventricular assist device: advantages and adverse events in comparison to contemporary devices. Expert Rev Med Devices 2014; 10:441-52. [DOI: 10.1586/17434440.2013.811851] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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24
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THOMAS ISACC, CORK DAVIDP, LEVY ANDREW, NAYAK HEMAL, BESHAI JOHNF, BURKE MARTINC, MOSS JOSHUAD. ICD Lead Parameters, Performance, and Adverse Events following Continuous-Flow LVAD Implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:464-72. [DOI: 10.1111/pace.12290] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 07/29/2013] [Accepted: 09/06/2013] [Indexed: 11/28/2022]
Affiliation(s)
- ISAC C. THOMAS
- Department of Medicine; Section of Cardiology; Heart Rhythm Center at the University of Chicago Medicine; Chicago Illinois
| | - DAVID P. CORK
- Department of Medicine; Section of Cardiology; Heart Rhythm Center at the University of Chicago Medicine; Chicago Illinois
| | - ANDREW LEVY
- Department of Medicine; Section of Cardiology; Heart Rhythm Center at the University of Chicago Medicine; Chicago Illinois
| | - HEMAL NAYAK
- Department of Medicine; Section of Cardiology; Heart Rhythm Center at the University of Chicago Medicine; Chicago Illinois
| | - JOHN F. BESHAI
- Department of Medicine; Section of Cardiology; Heart Rhythm Center at the University of Chicago Medicine; Chicago Illinois
| | - MARTIN C. BURKE
- Department of Medicine; Section of Cardiology; Heart Rhythm Center at the University of Chicago Medicine; Chicago Illinois
| | - JOSHUA D. MOSS
- Department of Medicine; Section of Cardiology; Heart Rhythm Center at the University of Chicago Medicine; Chicago Illinois
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25
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Saeed D, Albert A, Westenfeld R, Maxhera B, Gramsch-Zabel H, O'Connor S, Lichtenberg A, Winter J. Left ventricular assist device in a patient with a concomitant subcutaneous implantable cardioverter defibrillator. Circ Arrhythm Electrophysiol 2013; 6:e32-3. [PMID: 23778251 DOI: 10.1161/circep.113.000240] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Diyar Saeed
- Clinic for Cardiovascular Surgery, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
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