Role of implantable loop recorders in optimizing care for patients during and after left ventricular assist device support: a single centre experience.

BACKGROUND

Left ventricular assist devices (LVADs) are increasingly used in heart failure patients. Arrhythmias are common in those patients, including patients with LVADs, and the interplay between electrical activity and LVAD-related hemodynamic changes is critical for managing complications. While preexisting cardiac implantable electronic devices (CIEDs) can aid in monitoring, they are not always present, and the role of de novo implantable cardioverter-defibrillators (ICDs) in LVAD patients remains debated. Implantable loop recorders (ILRs) may offer a solution by enabling continuous monitoring and guiding management adjustments. This study assessed the outcomes of ILR use in LVAD patients at single tertiary centre

METHODS

We reviewed our cohort of LVAD patients with emphasis on those with ILR; indication, timing of implantation, interrogation data and management.

RESULTS

Out of 76 LVAD patients, 8 patients got an ILR. Average age at time of LVAD implantation was 24.3 years. Average time of LVAD support was 41.3 month, all with Continuous flow-LVADs. Indications for ILR implantation were frequent palpitation in five patients. In remaining three, it was indicated to exclude arrythmia as an aetiology for low flow state alarms. Average sensed R wave voltage was 0.3 mv, no noise or artifacts were detected. In 3 patients, intermittent high grade AV block was detected, so we stopped their beta-blockers and implanted a pacemaker in one of them. Atrial fibrillation (AF) was found in 3 patients. In one of them, this was after LVAD removal, so we got patient back on anticoagulation. Ventricular arrythmias were found in 2 patients, one with Premature Ventricular Contractions (PVCs), and the other had symptomatic sustained VT episodes that required amiodarone therapy. No arrhythmia related mortality occurred in the cohort.

CONCLUSIONS

With increasing cohort of LVAD patients worldwide, there is no consensus about device therapy post LVAD with individualized approaches for patients' assessment. ILR can be an excellent tool to monitor them. Moreover, in recovered patients, ILRs may help to diagnose arrythmias that could need intervention as AF and VT related to implantation site. In contrast to the reports about potential artifacts due to magnetic interference, no noise or artifacts were detected in our cohort.