Abstract 19920: Ventricular Tachycardia in Patients with Continuous Flow Left Ventricular Assist Devices: A Single Center Experience
Background: Ventricular tachycardia (VT) burden in patients with Left Ventricular Assist Devices (LVADs) is unclear. While LVADs are known to maintain hemodynamic stability during VT, they are paradoxically associated with increased VT post-operatively. Potential mechanisms include post-operative arrhythmogenic state, new scar formation and LVAD’s effect on calcium channels. AICD intervention increased morbidity in LVAD patients but without impact on mortality.
Methods: We retrospectively reviewed VT requiring AICD intervention (iVT) with either ATP or shocks in 85 patients with durable continuous flow LVADs. Data on iVT from 1 year prior to LVAD implant until transplant or death was analyzed for shock, syncope and hospitalization.
Results: Eighty five patients were identified, mean age 62.6 years (87% male) with a median follow-up of 272 days (23-1588).
Results displayed in Table 1.
Twenty-six (30.5%) post-LVAD patients had iVT, 12 of the 17 patients with pre-LVAD iVT (70.6%) had post-LVAD iVT and 14 of the 68 patients without pre-LVAD iVT (20.6%) had denovo iVT post-LVAD (p=0.0011). Syncope or presyncope occurred in 4 (15.38%) of these post-LVAD patients. Hospitalization for VT after 30 days occurred in 7% of LVAD patients. One patient died from protracted course of VT that decreased mixed venous oxygen, mean arterial pressure, and RV function.
Discussion: iVT post-LVAD was noted in 22.3% patients and was more common in those with ischemic etiology (p value=0.15). Pre-LVAD VT was a significant risk factor for post-LVAD iVT. The prevalence of VT one year pre and post LVAD is similar (20% and 23.5%) indicating that LVADs do not prevent VT nor decrease the number of shocks delivered (p value= 0.427) or hospital admissions.Death was rare (1.1%) and likely not due to primary VT. LVAD therapy conveys a mortality advantage to patient with iVT; however, ventricular arrhythmia should be aggressively managed post-LVAD to further reduce morbidity and hospitalizations.
- Arrhythmias, treatment of
- Advancing heart failure
- Ventricular arrhythmia
- Ventricular assist devices
- Ventricular tachycardia
Author Disclosures: P. Shivamurthy: None. H. Ganga: None. J. Ingrassia: None. H.B. Slim: None. J. Radojevic: None. J. Gluck: None. J. Kluger: None.
- © 2014 by American Heart Association, Inc.