Abstract 12765: Atrial Arrhythmias in Patients With Continuous-Flow Left Ventricular Assist Devices (CF-LVADs): The Incidence, the Risk, the Consequences
Background: The prevalence of atrial arrhythmias (AAs) is 50% in advanced HF patients (pts), but incidence of AAs post therapies like CF-LVADs is unclear. We sought to quantify the incidence of AAs, identify risk factors, and elucidate effects on survival, quality of life (QOL) and 6-minute walk distance (6MWD) in CF-LVAD pts.
Methods: Pts receiving a HeartMate (HM) II LVAD in the HMII bridge to transplant (n=490) and destination therapy (n=634) trials were included (n=1125). AAs requiring treatment were recorded, regardless of symptoms. Baseline information, survival, QOL and 6MWD were compared in pts with and without AAs. Using Cox Models with and without a 60-day blanking period, risk factors for early and late AAs were determined.
Results: There were 271 AAs in 231 pts (21%) in 1566 pt years. Most AAs were in 60 days and decreased thereafter. Pts with AAs were larger (p=.04), age<65 (p=.02), black (p=.02), had lower EFs (p=.049), higher BUN (p=.001) and creatinine (p=.01). There was no difference in HF etiology, LVAD indication, medications, CRT or pacemaker use or history of AAs. Pts with and without AAs had similar survival (p=.16). Significant multivariate risk factors for AAs were age≥65 (HR .72, .55-.94; p=.02), EF per 1% increase (HR .98, .95-.999; p=.04), and creatinine per unit increase (HR 1.51, 1.21-1.89; p<.001). Creatinine remained a risk factor for AAs post 60 days (HR 1.62, 1.03-2.54; p=.04). QOL improved in all, but pts with AAs had worse unadjusted QOL on both the Kansas City Cardiomyopathy and the Minnesota Living with HF Questionnaires (p<.001). All pts' 6MWD improved, but degree and rate of improvement over 6-24 months were lower in AA pts, adjusted for EF (p=.02).
Conclusions: CF-LVAD pts have AAs more commonly within 60 days with creatinine as a strong risk factor for early and late AAs. Although AAs do not negatively impact survival, examination of their association with stunted 6MWD improvement and worse QOL, whether due to AAs or their treatment, is warranted.
- © 2011 by American Heart Association, Inc.