Abstract 9594: Risk and Impact of Early and Late Ventricular Arrhythmias in Patients with Continuous-Flow Left Ventricular Assist Devices (CF-LVADs)
Introduction: Ventricular arrhythmias (VAs) are common in patients (pts) with LVADs, but most data were obtained from pts with pulsatile LVADs. The incidence, risk factors and impact of VAs in CF-LVAD pts are unknown.
Hypothesis: VAs in pts with CF-LVADs occur frequently in the first 60 days without decreasing survival or quality of life (QOL).
Methods: Pts in the HeartMate (HM) II bridge to transplant (BTT n=490) and destination therapy (n=634) trials who received a HM II LVAD were analyzed (n=1125). VAs were defined as those requiring intervention regardless of symptoms. Baseline characteristics, QOL and survival were compared between those with and without VAs. Risk factors were determined using Cox Models with and without 60-day post-implant blanking period.
Results: A total of 686 VAs in 437 pts (39%) occurred in 1566 patient years (.44 VAs/yr). Most VAs occurred early with 403 events in 29% of pts in first 60 days (2.39 VAs/yr). Survival did not differ in pts with and without VAs (p=.22). Pts with VAs were more likely to be younger than 65 (p<.001), black (p<.001), have lower EF (15.9 vs. 17.4, p<.001), BTT (p=.03), IABP before surgery (p=.009), and history of VAs (p<.001). There were no differences in HF etiology, beta-blocker use, inotropes or pump speed. Significant multivariate risk factors for VAs were age ≥ 65, lower EF, BUN, IABP and VA history. Only EF, IABP, and history of VAs remained significant risk factors for VAs occurring after 60 days. QOL improvements with the Kansas City Cardiomyopathy and Minnesota Living with Heart Failure Questionnaires were noted in all pts; however, pts with VAs had significantly worse unadjusted QOL on both instruments (p<.001).
Conclusions: VAs in CF-LVAD pts occur largely in the first 60 days without decreasing survival. Sicker pts (lower EF, presence of IABP) are at greater risk for early and late VAs, with history of prior VAs as the strongest predictor. Presence of VAs may serve as a marker for stunted improvement in QOL post CF-LVAD.
- © 2011 by American Heart Association, Inc.