Abstract 17132: Characteristics, Therapeutic Efficacy, and Clinical Implications of Ventricular Tachycardias Detected Early After Implant of Continuous-flow Left Ventricular Assist Device
Introduction: Ventricular tachycardias (VTs) frequently occur early after implant of continuous-flow left ventricular assist device (LVAD). Efficacy and optimal programming of implantable cardioverter-defibrillator (ICD)-based therapies in this population are not well understood. We aimed to assess the characteristics, ICD efficacy, and clinical implications of ICD-detected VTs within 30 days after LVAD implant.
Methods: Thirty-four patients, of 160 consecutive patients who received first LVAD implant at our institution between January 1, 2012 and March 1, 2014, had VTs within 30 days after LVAD implant. Of these, 21 patients had ICD intracardiac electrograms of ICD-treated VTs within 30 days after LVAD implant and were included in this study.
Results: There were 28 ICD-treated VTs in 21 study subjects (age 63±11 years, 76% male, 24% ischemic, 76% with prior VT). Most VTs (82%) were monomorphic. A minority (11%) of VTs initiated with short-long-short sequence; the remaining initiated with a single premature ventricular beat. Very early VTs (0-9 days post-LVAD implant) were faster and more heterogeneous (292±53ms) compared to VTs occurring 10-30 days after LVAD implant (351±21ms, p=0.03). A total of 43 antitachycardia pacing (ATP) and 25 shock therapies were delivered. ATP was attempted in 22 VTs; 3 VTs accelerated with ATP. 13 VTs terminated with ATP without escalation to shock; of these, 11 VTs terminated with first ATP (delivered at 87±3.9% TCL). Shocks were delivered for 14 VTs; first shock efficacy was 86%. Post-LVAD RV failure occurred in 13 (62%) study subjects. Very early VTs were associated with post-LVAD RV failure (p=0.01). In 11 (52%) subjects with cardiac resynchronization devices, higher percentage of biventricular pacing was associated lower odds of post-LVAD RV failure (p=0.048, OR 0.70).
Conclusions: ICD-detected VTs within 30 days after LVAD implant were predominantly monomorphic and faster earlier in this 30-day period. ATP terminated less than half of the observed VTs. The associations of very early VTs and amount of biventricular pacing with post-LVAD RV failure merit further study. Additional studies should be conducted to define optimal ICD programming in LVAD patients.
Author Disclosures: J.Y. Chyou: None. W. Whang: None. J. Dizon: None. A. Biviano: None. H. Garan: None. Y. Naka: None. P. Colombo: None. A.R. Garan: None.
- © 2016 by American Heart Association, Inc.