Abstract 19448: Ventricular Arrhythmias in Patients Following Continuous Flow Left Ventricular Assist Device Implantation
Background: Sustained ventricular arrhythmias (VA) (i.e. VT or VF) are common following continuous flow LVAD (CF-LVAD) implantation. Reports of VAs in this population have been retrospective, included short-term VADs, or focused predominantly on pulsatile flow devices.
Objective: In this study we aim to evaluate the prevalence and predictors of VAs in CF-LVAD patients, their clinical impact, and the need for ICDs in those patients.
Methods: All patients with CF-LVADs and an ICD presenting to our institution were enrolled and followed prospectively. The primary end-point was a composite of hemodynamically significant VA (causing hypotension, worsening CHF, or end-organ dysfunction) or admission as a result of VA. At subsequent hospitalizations or clinic visits, patients’ ICDs were interrogated to identify new VAs.
Results: Sixty-nine patients were enrolled. Follow up totaled 64.5 CF-LVAD-patient years. Sixty-five (94.2%) were men, 34 (49.3%) had ischemic cardiomyopathy, and average age was 62.9 + 11.9 years. Six (8.7%) had undergone catheter ablation for VT prior to surgery, 19 (27.5%) had experienced a VA 90 days prior to surgery, and 27 (39.1%) were taking an anti-arrhythmic drug at enrollment. Excluding VAs occurring within 30 days of surgery, 19 (27.5%) patients had 85 VAs for an event rate of 1.3 VAs/patient year. Twelve patients (17.4%) met the primary end-point. Predictors of the primary end-point were VAs occurring prior to surgery and use of anti-arrhythmic drug. There was a trend towards significance for ischemic cardiomyopathy and prior VT ablation.
Conclusions: Despite the support provided by CF-LVADs, VAs carry significant morbidity and pose risk for end organ damage and recurrent hospitalization. VAs pre-operatively and anti-arrhythmic use were associated with VA-related morbidities post-operatively. These patients may require more aggressive anti-arrhythmic therapies following surgery and ICDs continue to play a crucial role in their care.
- © 2012 by American Heart Association, Inc.