Abstract 16311: A Novel Implantable Cardio-Defibrillator Programming Strategy for Patients With Left Ventricular Assist Devices Reduces Shocks
Background: Ventricular arrhythmias (VA) complicate the management of patients with left ventricular assist devices (LVAD). Although LVADs improve hemodynamics, patients remain at high risk for VAs associated with painful implantable cardio-defibrillator (ICD) shocks and worsened clinical outcomes. No guidelines currently exist for ICD programming in pts with LVADs. We designed a novel ICD programming protocol to minimize shocks by terminating VA with extensive anti-tachycardia pacing (ATP) and defibrillating only when necessary. The purpose of this study was to determine the rate of ICD shocks and VA detection after implementation of the novel programming strategy.
Methods: Forty-two pts at UNC Chapel Hill with an LVAD and ICD underwent reprogramming. The reprogramming protocol included: ventricular fibrillation (VF) zone >220 bpm with ATP during/prior to charging; ventricular tachycardia (VT) zone >185 bpm with 12 bursts of ATP followed by a single shock; VT monitor zone >150 bpm. ATP time-out was disabled and detection was prolonged to 10 sec. Device interrogations were performed at routine LVAD clinic follow up and for pt symptoms. Data collection was performed with an approved institutional IRB protocol and included VA events and device therapy.
Results: Twenty-three pts (55%) reached 6 months of follow up or a VA event (88% male, age 59±13). 10/23 (43%) pts received therapy for a VA, 80% due to monomorphic VT. The average time to first VA event was 65 days (range 7-144 days). Importantly, only 3 pts received shocks (13%) and no pt received >1 shock. Pts who received therapy for VA were more likely to have ischemic cardiomyopathy (63% vs 38%) and history of VA prior to LVAD implantation (38% vs 31%).
Compared with prior to reprogramming, there was a marked reduction in shocks delivered (1796 vs 698 patient-days/shock) and a decrease in the number of shocks per VA event (1 vs 2.7 shocks per event). There were no admissions for untreated or undetected VA compared with 5 admissions in patients prior to reprogramming.
Conclusions: Implementation of a novel ICD programming protocol markedly reduced the rate of shocks without decreasing VA detection. This is an important advance and may have widespread application for the care of this complicated pt population.
- Ventricular assist devices
- Implantable cardioconvert defibrillator
- Arrhythmias, treatment of
- Ventricular tachycardia
- Heart failure
- © 2013 by American Heart Association, Inc.