Electromagnetic interference from left ventricular assist devices in patients with subcutaneous implantable cardioverter‐defibrillators

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.