Abstract 13001: Ventricular Assist Devices Do Not Treat Ventricular Arrhythmias: Significant Morbidity Persists After Implantation
INTRODUCTION. Ventricular assist devices (VADs) have emerged as pivotal treatment options for patients with advanced heart failure. Despite robust left ventricular unloading, the right ventricle remains unsupported and susceptible to hemodynamic perturbations, including those from ventricular arrhythmias (VAs). Little is known about the epidemiology and influence of sustained VAs on outcomes in patents with VADs.
METHODS. We retrospectively collected and analyzed data from all consecutive patients receiving a continuous flow VAD at UNC Hospital from Jan 2006-Oct 2010. Patient demographics, medical therapies, resource use, and outcomes were recorded. Descriptive statistics were generated and multivariable logistic regression was used to assess the independent association of clinical variables on post-implant VAs.
RESULTS. Twenty-one out of 61 patients (34%) had sustained VAs after VAD. The majority with post-implant VAs were male (62%), had history of HTN (62%) and hyperlipidemia (52%), and had non-ischemic cardiomyopathy (62%). Compared with patients who did not experience VAs after VAD, patients with post-VAD VAs more often had pre-VAD VAs (67% v. 20%, p=0.001), an ICD (86% vs. 43%, p=0.048), and appropriate ICD discharge prior to mechanical circulatory support (44.4% v. 12.5%, p=0.046). The length-of-stay during implant hospitalization was similar regardless of post-VAD VAs, but those with VAs had twice the rate of rehospitalization (2.8 v. 1.2 admissions/patient) and required more anti-arrhythmic medications (2.3 v. 0.6 antiarrhythmics/patient). Post-VAD VAs were often refractory to medical therapy, requiring electrical cardioversion in the majority of cases (71%). Using multivariable logistic regression, only history of prior VAs was found to be associated with the development of post-VAD VAs (OR 6.51, 95% CI 1.48-28.8, p=0.013).
CONCLUSIONS. VAs following VAD implantation are often refractory to conservative therapy and are associated with frequent hospital readmissions. Since only pre-implant ventricular tachycardia was associated with post-VAD VAs, arrhythmia burden may have a significant impact on future outcomes. Additional study should focus on utilizing arrhythmia burden to optimize patient selection for VAD.
- © 2011 by American Heart Association, Inc.