Introduction: Patients with continuous flow Left Ventricular Assist Devices (LVAD) and concomitant Cardiac Implantable Electrical Devices (CIED) are prone for device and lead-related complications requiring intervention.
Hypothesis: We evaluated the incidence and characteristics of CIED-related procedures and complications and their association with survival in a multicenter LVAD cohort.
Methods: We retrospectively reviewed data on 480 LVAD patients with a CIED from 5 centers. Of the 480, 235 patients had accurate long-term CIED follow-up data and were used for this analysis. Kaplan Meier analysis was used to assess survival differences between patients with CIED-related complications versus those who did not.
Results: Of 235 patients with an LVAD and a CIED (Age 58±13, 80% male), 130 had a CRT-D and 105 had ICD only. During a median LVAD follow-up of 692 days, 103 patients required a CIED generator replacement with CRT-D patients having a significantly higher rate of generator replacement compared to the ICD only group (68[52%] vs 35[33%], p=0.003). A CIED or lead-related complication occurred in 36 (28%) of CRT-D patients and 16 (15%) of the ICD patients (p=0.06). 20 (15%) patients in the CRT-D group and 14 (13%) in the ICD group underwent lead removal or extraction during follow-up (p=0.5). Both the CRT-D and ICD groups had comparable incidences of pocket hematoma (8% vs 5%), pocket and/or lead infection (9% vs 4%), and lead malfunction (8% vs 9%). Kaplan Meier analysis showed no significant survival difference between those who had a CIED-related complication versus those who did not (log rank p= 0.7).
Conclusions: CIED related procedures are common in LVAD patients. Compared to ICD only, continued CRT-D post-LVAD resulted in a significantly higher number of generator changes and showed a trend towards higher device or lead related complications. CIED-related complications were not associated with reduced survival.