Abstract 18639: Ventricular Tachycardia Events Are Associated With Admissions for Infection or Heart failure in Patients With Left Ventricular Assist Devices and Implantable Cardio-Defibrillators
Background: Left ventricular assist devices (LVAD) have dramatically affected the treatment of end stage heart failure (HF), however preventing readmissions remains critical to optimize patient quality of life. Following LVAD implantation, pts are readmitted most commonly for infection, HF, arrhythmia and anemia. We designed a novel implantable cardio-defibrillator (ICD) programming protocol for pts with LVADs and ICDs to maximize ventricular arrhythmias (VA) detection and minimize shocks. We hypothesized that increasing detection of VA in LVAD pts may reduce readmission rates.
Methods: Forty-two pts at UNC with an LVAD and ICD underwent reprogramming. The protocol included: ventricular fibrillation >220 bpm; ventricular tachycardia (VT) >185 bpm with 12 bursts of ATP then a single shock; VT monitor >150 bpm. Device interrogations were performed at LVAD clinic follow up, for symptoms, and at the time of readmission. Data was collected with an approved institutional IRB.
Results: During an average follow up of 11.3 months before and 7.4 months after reprogramming, there were 53 unplanned admissions (21 admissions after ICD reprogramming). After reprogramming 5 admissions (23% - 1438 patient-days/admit) were for HF or VA. Prior to reprogramming there were 15 HF/VA admissions (728 patient-days/admit). After reprogramming 4 admissions (18%) were for bacterial infections (5 prior to reprogramming). The remaining were primarily for anemia (17%) or neurologic symptoms (36%). After reprogramming, arrhythmias were detected on ICD interrogation in 3 of 5 HF and 2 of 4 bacterial infection admissions. 40% were due to sustained VA >10 sec and 60% were due to supraventricular tachycardia. By comparison 0/13 of the other admissions had documented ICD arrhythmias.
Conclusions: Following implementation of a novel ICD programming protocol to increase detection of VA, there was a marked decrease in admissions for cardiac diagnoses. ICD interrogations found VA events were associated with admissions for HF and infection. HF and infections may cause hemodynamic perturbations that result in arrhythmias detected by ICDs with appropriate programming. Our data suggests that ICD data may augment available techniques to assess and triage this patient population.
- Ventricular assist devices
- Implantable cardioconvert defibrillator
- Ventricular tachycardia
- Heart failure
- Quality improvement
- © 2013 by American Heart Association, Inc.