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Case Reports
. 2025 Jun 4;30(13):103508.
doi: 10.1016/j.jaccas.2025.103508.

Left Ventricular Assist Device Implantation in the Presence of Substernal Extravascular Implantable Cardioverter-Defibrillator

Roland Papp  1 , Levente Molnár  2 , Éva Straub  2 , Endre Németh  2 , Endre Zima  2 , Ádám Levente Jermendy  2 , Balázs Sax  2 , Csilla Czimbalmos  2 , István Hartyánszky  2 , Béla Merkely  2
Affiliations
Case Reports

Left Ventricular Assist Device Implantation in the Presence of Substernal Extravascular Implantable Cardioverter-Defibrillator

Roland Papp et al. JACC Case Rep. .

Abstract

Extravascular implantable cardioverter-defibrillator is a recently developed substernal system to prevent sudden cardiac death. Extravascular devices, such as subcutaneous and substernal implantable cardioverter-defibrillators, were designed to avoid the possible complications of conventional transvenous leads. However, their combination with a left ventricular assist device (LVAD) is often challenging. Electromagnetic interference generated by the LVAD may affect previously implanted cardioverter-defibrillators, particularly subcutaneous extravascular devices. To our knowledge, this is the first reported experience of the concomitant use of an extravascular implantable cardioverter-defibrillator with a durable LVAD.

Keywords: cardiac assist devices; substernal extravascular implantable cardioverter-defibrillator; systolic heart failure; ventricular fibrillation.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Papp has received lecture fees from Medtronic. Dr Molnár has received lecture fees from Medtronic and Abbott. Dr Zima has received lecture and advisory fees from Medtronic and Abbott. Dr Sax and Hartyánszky have received lecture fees from Abbott. Dr Merkely has received grants, lecture fees, and contracts from Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
EV-ICD Electrograms Electrograms of the extravascular implantable cardioverter-defibrillator (EV-ICD) before (A) and after (B to D) left ventricular assist device (LVAD) implantation. Ventricular fibrillation detection and treatment were successful without any electromagnetic interference (EMI) before LVAD implantation (A). EMI was present after LVAD implantation, which resulted in oversensing episodes during septic shock (B). After the patient recovered, the sensing amplitude increased (red box) (C) compared with the decreased sensing amplitude during septic shock (red box) (B). Ventricular tachycardia detection was successful; ICD therapy was switched off during the early postoperative course; therefore, tachycardia therapy was not delivered (D).
Figure 2
Figure 2
Changes in EV-ICD Parameters After LVAD Implantation Lead impedance and sensing parameters immediately decreased after left ventricular assist device (LVAD) implantation (black arrows indicate February 21, 2023). Despite the observed changes, extravascular implantable cardioverter-defibrillator (EV-ICD) function remained appropriate.
Figure 3
Figure 3
Changes in EV-ICD Position Compared With the Heart Using Preoperative and Postoperative CT Images Preoperative (A) and postoperative (B) computed tomography (CT) images in sagittal plane and postoperative volume rendered CT reconstruction images in lateral (C) and anteroposterior (D) views. The position of the heart changed after left ventricular assist device (LVAD) implantation: the level of the left main coronary artery orifice compared with the tip of the electrode was lower preoperatively (A) and moved higher postoperatively (B) (dashed line, double arrow). The heart’s position was affected by the distended bowels (green arrow). The final position of the LVAD compared with the extravascular implantable cardioverter-defibrillator (EV-ICD) device can be observed on the reconstruction images (C and D).
See this image and copyright information in PMC

References

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