Overall efficacy and safety of combined continuous-flow LVAD and ICD were recently
- Pecha S.
- Wilke I.
- Bernhardt A.
- et al.
Clinical experience of combined HeartWare ventricular assist device and implantable
cardioverter defibrillator therapy.
]. However, several cases of electromagnetic interference between ICD and LVAD have
been reported, such as telemetry instability between ICD and its programmer or inappropriate
ICD therapies caused by noise arising from LVAD [
- Matthews J.C.
- Betley D.
- Morady F.
- et al.
Adverse interaction between a left ventricular assist device and an implantable cardioverter
- Reddy P.
- Benditt D.G.
- Adabag S.
Electromagnetic device-device interaction between a new generation implantable pacemaker
and left ventricular assist device: recognition and potential solutions.
- Labedi M.R.
- Alharethi R.
- Kfoury A.G.
- et al.
Electromagnetic interference of automatic implantable cardioverter defibrillator and
HeartWare left ventricular assist device.
- Netzler P.C.
- Vasuki N.
- Peura J.L.
- et al.
Interactions between a left ventricular assist device and implantable cardioverter-defibrillator.
- Boudghène-Stambouli F.
- Boulé S.
- Goéminne C.
- et al.
Clinical implications of left ventricular assist device implantation in patients with
an implantable cardioverter-defibrillator.
]. However, these reports were cases which used HeartMate® II (Thoratec Corporation,
Pleasanton, CA, USA) or HeartWare® (HeartWare International, Inc., Framingham, MA,
USA) with ICD (St. Jude Medical Corporation, Sunnyvale, CA, USA or Sorin Group, Milan,
MI, Italy). Here we report novel electromagnetic interference between CRT-D (COGNIS®,
Boston Scientific, St. Paul, MN, USA) and LVAD (DuraHeart®, Terumo Corporation, Shibuya,
Tokyo, JAPAN). A 35-year-old man who had been diagnosed in a health examination in
2001 with premature ventricular contraction, was then diagnosed with dilated cardiomyopathy,
by endomyocardial biopsy, in 2003. Whereas the best medical treatments for severe
heart failure had been done, he was repeatedly hospitalized. Left ventricular ejection
fraction was reduced to 20% with wide QRS complex, and non-sustained ventricular tachycardia
was also observed. CRT-D: Contak RENEWALl® (Boston Scientific, St. Paul, MN, USA)
was implanted in 2003. CRT-D generator was replaced by COGNIS 100-D® (Boston Scientific,
St. Paul, MN, USA) due to low battery in 2010. However, the frequency of hospitalization
was gradually increased and a LVAD (DuraHeart, Terumo Corporation, Shibuya, Tokyo,
Japan) was implanted as a bridge to transplantation (Fig. 1
A ). During LVAD implantation surgery, ventricular arrhythmia therapeutic capability
was turned off to avoid inappropriate therapy caused by electromagnetic interference
of the electrocautery scalpel. Just after the LVAD was inserted and started, the programming
head of CRT-D programmer (Boston Scientific, St. Paul, MN, USA) was placed on the
skin above the CRT-D generator to communicate with the CRT-D, and incessant intermittent
telemetry failure was observed (Fig. 1
B). In the perioperative period, power delivery was supplied by hospital console,
which is the attached power supply and modulator of rotation setting of the LVAD.
During telemetry failure, no information was obtained by the programmer and any manipulation
from the CRT-D programmer could not be accepted. Abnormal pacing or sensing manner
was not suspected by other biomonitors. Even after moving to the cardiac care unit,
incessant intermittent telemetry failures were also observed in the same action. We
tried to move the cable of the programming head and programmer itself from VAD insertion
site to avoid this telemetry failure. However, no position could resolve this intermittent
telemetry failure. We tested shielding of these devices by steel shielding [
- Biviano A.
- Mancini D.
- Naka Y.
- et al.
Overcoming electromagnetic interference by LVADs on ICD function by shielding the
ICD programmer wand and extension cable.
] (Fig. 1
C). When we covered the skin above the CRT-D generator and that above the LVAD pump,
this telemetry failure disappeared. In addition, when we switched the origin of power
supply to battery, this telemetry loss also completely disappeared. After discharge,
this patient had no problems with CRT-D and LVAD function including wand-based telemetry,
because the patient always used a battery-derived power supply. We confirmed this
interference in vitro using the same models of LVAD, CRT-D, and programmer (Fig. 2
A ). In this case, distance between the CRT-D generator and the LVAD pump was 13 cm (Fig. 1
A). We tested whether the CRT-D generator located at 13 cm away from the LVAD pump was affected (Fig. 2
B). As expected, the hospital console-powered LVAD repeatedly interfered with the
communication of the CRT-D and its programmer (Fig. 2
C). This phenomenon is only observed when the CRT-D generator is located in a horizontal
direction to the LVAD, but not in a vertical direction (Fig. 2
C). Battery-powered LVAD did not provoke this interference as clinically observed
C). In addition, we measured the power of electromagnetic waves generated from currently
used LVASs including DuraHeart using originally-developed equipment. Dominant frequency
from DuraHeart was 100 kHz and those of HeartMateII and EvaHeart are 7.2 KHz and 30 Hz as manufacture's report, respectively. Whereas electromagnetic wave from HeartMate
II was detected to 24 cm from LVAS pump, those of DuraHeart and EvaHeart were not detected over 8 cm (Fig. 2
D). These results suggested that electromagnetic wave from DuraHeart could not reach
the location of CRT-D generator.