To Exchange or Not: Defibrillators, Ventricular Assist Devices and Hematomas

Abstract

Purpose To assess peri-procedural complications in left ventricular assist device (LVAD) patients undergoing implantable cardiac defibrillator (ICD) generator exchange for primary prevention of sudden cardiac death. Methods In this single-center study, we retrospectively analyzed all current patients with a durable LVAD (n=39) who underwent ICD generator exchange between January 2014 and August 2018. Data was collected from electronic medical records and clinical outcomes analyzed included death, stroke, infection, any hematoma formation, need for blood products transfusion and hospital admission for above reasons within 30 days of ICD generator exchange. Results Of 39 current LVAD patients 15 (38%) underwent an ICD generator exchange. 14/15 (93%) patients were male and mean age was 73 ± 8.2 years. 11/15 patients (73.3%) had the ICD implanted for primary prevention vs. 4/15 (26.7%) had the ICD for secondary prevention. In the primary prevention ICD cohort, none of the patients received a defibrillator shock during the time course of having the device. Mean follow-up from the date of ICD generator exchange was 2.2 patient years. Pocket hematoma was noted in 3/11 (27.2%) primary prevention patients who underwent ICD generator exchange, of which 1 patient was hospitalized for observation of the hematoma. No patients required blood products. All 3 patients who developed pocket hematoma were on antiplatelet therapy with aspirin as well as warfarin with INRs ranging from 2.2-3.5. There were no infections as a result of ICD generator exchange. Conclusion In this single center study, pocket hematoma formation was noted in 27% of the primary prevention cohort who underwent ICD generator exchange. No patients required a blood product transfusion or developed an infection. Of note, no patients received an ICD shock during the course of follow-up. This raises a clinically relevant central question on indication of ICDs and generator exchange in patients with LVADs and no prior history of arrhythmia.