Incidence, Predictors, and Significance of Ventricular Arrhythmias in Patients With Continuous-Flow Left Ventricular Assist Devices: A 15-Year Institutional Experience

Brian D. Greet, Deep Pujara, David Burkland, Mark Pollet, Deepthi Sudhakar, Francia Rojas, Briana Costello, Alexander Postalian, Zachary Hale, Ben Jenny, Carol Lai, Kenneth Igbalode, Divesh Wadhera, Ajith Nair, Masahiro Ono, Jeffrey Morgan, Leo Simpson, Andrew Civitello, Jie Cheng, Nilesh Mathuria

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Objectives: The aim of this study was to evaluate the incidence, predictors, and associated mortality of pre-implantation, early, and late ventricular arrhythmias (VAs) in patients receiving continuous-flow left ventricular assist devices (CFLVADs). Background: VAs are common both pre- and post-implantation of left ventricular assist devices. Limited data exist on their prognostic impact in contemporary CFLVADs. Methods: A retrospective review was performed to identify patients who underwent CFLVAD implantation between 2000 and 2015 with 2 years of follow-up. All VAs, defined as ventricular fibrillation, ventricular tachycardia lasting >30 s, or a ventricular rhythm requiring defibrillation, were analyzed. VAs occurring within 30 days of implantation were defined as early. Recorded outcomes included death and receipt of cardiac transplant. Results: A total of 517 patients were included for analysis. Early VAs were associated with a significant reduction in survival (hazard ratio: 1.83; 95% confidence interval: 1.28 to 2.61; p = 0.001) compared with patients with late or no VAs. Pre-implantation variables independently predictive of early VAs included prior cardiac surgery (odds ratio: 1.90; 95% confidence interval: 1.09 to 3.32; p = 0.023) and pre-CFLVAD ventricular tachycardia storm (odds ratio: 3.15; 95% confidence interval: 1.49 to 6.69; p = 0.003). The incidence of early VAs from 2000 to 2007 was as high as 47%, whereas the highest incidence from 2008 to 2015 was <22%. Conclusions: VAs within 30 days after CFLVAD implantation are associated with an increased risk for death. Predictors of early VAs include prior cardiac surgery and pre-CFLVAD ventricular tachycardia storm. Temporal trends have shown a decrease in VA from 2000 to 2015. Strategies to reduce arrhythmia burden shortly after CFLVAD implantation warrant further investigation.

Original languageEnglish (US)
Pages (from-to)257-264
Number of pages8
JournalJACC: Clinical Electrophysiology
Volume4
Issue number2
DOIs
StatePublished - Feb 2018

Keywords

  • cardiac arrhythmia
  • continuous-flow left ventricular assist device
  • left ventricular assist device
  • ventricular arrhythmia
  • ventricular fibrillation
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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