Author + information
- Received February 24, 2020
- Accepted April 15, 2020
- Published online September 21, 2020.
- Eric Black-Maier, MDa,
- Robert K. Lewis, MD, PhDa,∗ (, )
- Rahul Loungani, MHSb,
- Michael Rehorn, MDa,
- Daniel J. Friedman, MDc,
- Muath Bishawi, MDd,
- Jacob N. Schroder, MDd,
- Carmelo A. Milano, MDd,
- Jason N. Katz, MD, MHSb,
- Chetan B. Patel, MDb,
- Joseph G. Rogers, MDb,
- Donald D. Hegland, MDa,
- Kevin P. Jackson, MDa,
- Camille Frazier-Mills, MD, MHSa,
- Sean D. Pokorney, MDa,
- James P. Daubert, MD, MHSa and
- Jonathan P. Piccini, MD, MHSa
- aDivision of Electrophysiology, Duke University Medical Center, Durham, North Carolina
- bDivision of Cardiology, Duke University Medical Center, Durham, North Carolina
- cDivision of Electrophysiology, Yale University School of Medicine, New Haven, Connecticut
- dDivision of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
- ↵∗Address for correspondence:
Dr. Robert K. Lewis, Electrophysiology Section, Duke University Medical Center, 2301 Erwin Road, Durham, North Carolina 27710.
Objectives This study sought to determine the indications, characteristics, and outcomes of cardiovascular implantable electronic device (CIED) surgery in patients with LVAD.
Background Many patients with a left ventricular assist device (LVAD) will require implantable cardioverter-defibrillator generator change or device revision or are candidates for de novo implantable cardioverter-defibrillator implantation following LVAD implantation.
Methods We performed an observational retrospective study of all LVAD recipients who subsequently underwent CIED surgery at Duke University Hospital from 2009 to 2019.
Results A total of 159 patients underwent CIED surgery following LVAD implantation, including generator change (n = 93), device revision (n = 38), and de novo implant (n = 28). The median (interquartile range) time from LVAD implantation to CIED surgery was 18.1 months (5.5 to 35.1 months). Pre-operative risk for infection was elevated in the overall cohort with a median (interquartile range) Prevention of Arrhythmia Device Infection Trial (PADIT) score of 7.0 (5.0 to 9.0). Pocket hematoma occurred in 21 patients (13.2%) following CIED surgery. Antimicrobial envelops were used in 43 patients (27%). Device infection due to CIED surgery occurred in 5 (3.1%) patients and occurred only in patients who developed post-operative pocket hematoma (p < 0.001). Mortality at 1 year following CIED surgery was 20% (n = 32).
Conclusions CIED surgery following LVAD implantation is associated with an increased risk for pocket hematoma and CIED infection. Further studies are needed to determine the risk-benefit ratio of CIED surgery in patients with LVADs.
Dr. Black-Maier has received research support from Boston Scientific. Dr. Lewis serves as a consultant to Philips, Medtronic, and Boston Scientific. Dr. Loungani has received research support from Boston Scientific and Pfizer. Dr. Rehorn has received research support from Pfizer and Boston Scientific. Dr. Friedman has received research support from Boston Scientific, Biosense Webster, and Abbott; has received educational grants from Boston Scientific, Medtronic, Abbott, and Biotronik; and has received consulting fees from Abbott and Atricure. Drs. Bishawi and Milano have received research support from Abbott and Medtronic. Dr. Katz has received research support from Abbott. Dr. Patel has served as a consultant for Abbott Labs. Dr. Hegland serves as consultant to Abbott, Boston Scientific, Medtronic, and Philips. Dr. Jackson has served as a consultant for Medtronic and Boston Scientific. Dr. Pokorney has received research grants from Boston Scientific, Janssen Pharmaceuticals, Bristol-Myers Squibb, Pfizer, and Gilead; has received Advisory Board support from Boston Scientific, Medtronic, Pfizer, and Bristol-Myers Squibb; has received consulting support from Janssen Pharmaceuticals; and has received Speakers Bureau support from Zoll. Dr. Daubert has received research funding from Medtronic and Abbott; and has received honoraria from Medtronic, Boston Scientific, Abbott, Biotronik, Microport, Phillips, Biosense, VytronUS, and Farapulse. Dr. Piccini has received grants for clinical research from Abbott, American Heart Association, Association for the Advancement of Medical Instrumentation, Bayer, Boston Scientific, NHLBI, and Philips; and serves as a consultant to Abbott, Allergan, ARCA Biopharma, Biotronik, Boston Scientific, LivaNova, Medtronic, Milestone, Myokardia, Sanofi, Philips, and Up-to-Date. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Jean-Claude Deharo, MD, served as Guest Editor for this paper. Katja Zeppenfeld, MD, served as Guest Editor-in-Chief for this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received February 24, 2020.
- Accepted April 15, 2020.
- 2020 American College of Cardiology Foundation
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