We introduced a simple technique to eliminate electromagnetic interference between a left ventricular assist device (LVAD) and an implantable cardioverter-defibrillator (ICD). A 43-year-old male with heart failure and a reduced ejection fraction (HFrEF) who had an ICD presented with decompensated heart failure and received an LVAD as a bridge to transplant. Remote monitoring showed persistent atrial fibrillation causing an inappropriate ICD shock leading to a decision to disable shock therapies. However, an in-office interrogation was unsuccessful due to electromagnetic interference. Patient was instructed to extend his arm above his head on the ipsilateral side of the ICD, thus increasing the distance between LVAD and ICD, eliminating the interaction to allow reprogramming of the device.
Twiddler’s syndrome is a rare complication where a pacemaker or implantable cardioverter-defibrillator (ICD) is displaced with or without patient manipulation of their device. There are reports on transvenous devices but a paucity of data on subcutaneous devices. A 50-year-old male with hypertrophic cardiomyopathy and non-sustained ventricular tachycardia underwent subcutaneous-ICD (S-ICD) implantation for primary prevention. Remote device interrogation 4 weeks after device placement reported a shock due to “ventricular fibrillation”. It also showed abnormal lead impedance. Chest X-ray showed lead was dislodged and coiled around the pulse generator. Patient underwent lead revision and device replacement without further complications.