RESUMO
BACKGROUND: Left ventricular assist devices (LVAD) are increasingly used in patients with advanced heart failure, many of whom have been or will be implanted with an implantable cardioverter defibrillator (ICD). Interaction between both devices is a matter of concern. Subcutaneous ICD (S-ICD) obtains its signals through subcutaneous vectors, which poses special challenges with regards to adequate performance following LVAD implantation. CASE SUMMARY: We describe the case of a 24-year-old man implanted with an S-ICD because of idiopathic dilated cardiomyopathy, severe biventricular dysfunction, and self-limiting sustained ventricular tachycardias. After the implantation of a HeartMate 3™ (Left Ventricular Assist System, Abbott) several months later, the S-ICD became useless because of inappropriate sensing due to electromagnetic interference and attenuation of QRS voltage. DISCUSSION: We reviewed the reported cases in PubMed about the concomitant use of S-ICD and LVAD. Seven case reports about the performance of S-ICD in patients with an LVAD were identified, with discordant results. From these articles, we analyse the potential causes for these differing results. Pump location and operating rates in LVAD, as well as changes in the subcutaneous-electrocardiogram detected by the S-ICD after LVAD implantation are related to sensing disturbances when used in the same patient.
RESUMO
The gap of standardization for conducted and field coupled electromagnetic interferences (EMI) in the 2-150 kHz frequency range can lead to Electromagnetic Compatibility (EMC) problems. This is caused by power systems such as Pulse Width Modulation (PWM) controlled rectifiers, photovoltaic inverters or charging battery units in electric vehicles. This is a very important frequency spectral due to interferences generated in a wide range of devices and, specifically, communication problems in the new technologies and devices incorporated to the traditional grid to convert it into a Smart Grid. Consequently, it is necessary to provide new solutions to attenuate this kind of interference, which involves finding new materials that are able to filter the electromagnetic noise. This contribution is focused on characterizing the performance of a novel material based on nanocrystalline and comparing it to most common material compositions such as MnZn and NiZn. This research is carried out from the point of view of the manufacturing process, magnetic properties and EMI suppression ability. This last item is carried out through two analysis procedures: a theoretical method by determining the attenuation ratio by measuring impedance parameter and proposing a new empirical technique based on measuring directly the insertion loss parameter. Therefore, the main aim of this characterization process is to determine the performance of nanocrystalline compared to traditional cable ferrite compositions to reduce the interferences in this controversial frequency range. From the results obtained, it is possible to deduce that nanocrystalline cable ferrite provides the best performance to filter the electromagnetic noise in the 2-150 kHz frequency range.