• Heart Rhythm · Dec 2017

    Observational Study

    Predictors of ventricular arrhythmia after left ventricular assist device implantation: A large single-center observational study.

    • Elena Efimova, Julia Fischer, Livio Bertagnolli, Borislav Dinov, Simon Kircher, Sascha Rolf, Philipp Sommer, Andreas Bollmann, Sergio Richter, Anna Meyer, Jens Garbade, Gerhard Hindricks, and Arash Arya.
    • Heart Center Leipzig, Department of Electrophysiology, Leipzig, Germany.
    • Heart Rhythm. 2017 Dec 1; 14 (12): 1812-1819.

    BackgroundVentricular arrhythmias (VAs) are common in patients after left ventricular assist device (LVAD) implantation.ObjectiveThe purpose of this study was to determine the predictors of VAs and their impact on mortality in LVAD patients.MethodsA total of 98 consecutive patients with an implantable cardioverter-defibrillator (ICD) (86 [88%] male, mean age 57 ± 10 years), 57 [58%] with nonischemic dilated cardiomyopathy) who had received an LVAD between May 2011 and December 2013 at our institution were included in the study.ResultsMean left ventricular ejection fraction and left ventricular end-diastolic diameter were 20% ± 8% and 73 ± 11 mm, respectively. Seventy-three patients (75%) had atrial fibrillation (AF). During the 12 months before LVAD implantation, 38 patients (39%) had experienced ≥1 episode of VAs (11.5 ± 20) requiring ICD therapies. The number of patients with VAs was comparable among all types of ICDs (P = .48). During the 12-month follow-up after LVAD implantation, 48 patients (49%) experienced ≥1 episode of VAs (30 ± 98) with appropriate ICD therapies. The prevalence of VAs was significantly higher among patients with pre-LVAD VAs compared to those without VAs during the year before LVAD implantation (66% vs 38%; P = .008). In a binary multiple logistic regression analysis, pre-LVAD VAs (hazard ratio 5.36, 95% confidence interval 2.0-14.3; P = .001) and AF (hazard ratio 3.1, 95% confidence interval 1.1-11.9; P = .024) predicted post-LVAD VAs.ConclusionPre-LVAD VAs and AF predict the occurrence of VAs after LVAD implantation. According to the latest data on the negative impact of post-LVAD VAs on all-cause mortality, further studies should clarify the reasonability of maintaining sinus rhythm in patients with AF and/or prophylactic catheter ablation of ventricular tachycardias before LVAD implantation.Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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