Left Ventricular Assist Device Implantation in the Presence of Substernal Extravascular Implantable Cardioverter-Defibrillator

Figures

• 

  Figure 1. EV-ICD Electrograms Electrograms of the extravascular implantable cardioverter-defibrillator (EV-ICD) before (A) and after (B to D) left ventricular assist device (LVAD) implantation. Ventricular fibrillation detection and treatment were successful without any electromagnetic interference (EMI) before LVAD implantation (A). EMI was present after LVAD implantation, which resulted in oversensing episodes during septic shock (B). After the patient recovered, the sensing amplitude increased (red box) (C) compared with the decreased sensing amplitude during septic shock (red box) (B). Ventricular tachycardia detection was successful; ICD therapy was switched off during the early postoperative course; therefore, tachycardia therapy was not delivered (D).

• 

  Figure 2. Changes in EV-ICD Parameters After LVAD Implantation Lead impedance and sensing parameters immediately decreased after left ventricular assist device (LVAD) implantation (black arrows indicate February 21, 2023). Despite the observed changes, extravascular implantable cardioverter-defibrillator (EV-ICD) function remained appropriate.

• 

  Figure 3. Changes in EV-ICD Position Compared With the Heart Using Preoperative and Postoperative CT Images Preoperative (A) and postoperative (B) computed tomography (CT) images in sagittal plane and postoperative volume rendered CT reconstruction images in lateral (C) and anteroposterior (D) views. The position of the heart changed after left ventricular assist device (LVAD) implantation: the level of the left main coronary artery orifice compared with the tip of the electrode was lower preoperatively (A) and moved higher postoperatively (B) (dashed line, double arrow). The heart’s position was affected by the distended bowels (green arrow). The final position of the LVAD compared with the extravascular implantable cardioverter-defibrillator (EV-ICD) device can be observed on the reconstruction images (C and D).