Abstract 13332: Ventricular Arrhythmias in Patients With Continuous-flow Left Ventricular Assist Devices
Introduction: Ventricular arrhythmias (VAs) pose a significant burden in patients with continuous flow left ventricular assist devices (cfLVADs). However, the incidence, risk factors, and impact on survival are not yet well-described.
Hypothesis: We hypothesized that there were demographic, hemodynamic, and comorbid condition parameters that would predict post-VAD arrhythmias and mortality.
Methods: We performed a retrospective analysis of 106 consecutive patients undergoing placement of cfLVADs between April 2007 and September 2012. Exploring the outcomes of early VA (occurring during the index hospitalization), late VA (occurring after discharge) and death, we compared demographic, comorbid, pharmacologic, and clinical data. Time to event analyses were undertaken to identify predictors of the outcomes.
Results: Most subjects were men (73%) with non-ischemic heart failure (70%) and an ICD (92%) in place. Forty six (43%) patients died. Pre-LVAD VA (hazard ratio [HR] 5.99, p=0.048), chronic kidney disease (HR 2.09, p=0.025) and diabetes (HR 3.61, p<0.0001) independently c68:369orrelated with mortality in the time to event analysis. Pre-LVAD VAs occurred in 30 (29%) patients whereas post-LVAD VAs occurred in 33 (31%). The median time to an early VA was 6 days in the 19 patients with an event during the index hospitalization. Patients with an early VA were older (63 vs. 57, p=0.027) and had a lower pre-operative RVSP (23 vs. 29, p=0.03). Late VAs occurred in 19 (23%) of the 82 patients surviving the index hospitalization. The median time to event was 419 days. Predictors of time to late VA included pre-LVAD appropriate ICD therapy (HR 7.0, p=0.007) and baseline antiarrhythmic use (HR 6.8, p=0.005).
Conclusions: Ventricular arrhythmias following LVAD placement are common and predicted by pre-LVAD arrhythmia and ICD therapy, comorbid conditions and medication use. For the rare patient without an ICD placed pre-LVAD, post-operative implantation should be considered.
- © 2013 by American Heart Association, Inc.