Effects of left ventricular assist device therapy on ventricular arrhythmias

In a retrospective study, we sought to evaluate the effect of left ventricular assist device (LVAD) therapy on ventricular tachyarrhythmias in patients with advanced congestive heart failure.

Despite the increasing use of LVAD as a bridge to cardiac transplantation, our knowledge regarding its effect on ventricular arrhythmias is currently limited to small series. Little is known about the prevalence, predictors, and clinical consequences of ventricular arrhythmias in LVAD recipients.

We reviewed the pre- and post-LVAD course of the last 100 consecutive adult patients to receive a HeartMate LVAD (Thoratec Laboratories Corp., Pleasanton, California) at our institution. All ventricular arrhythmias sustained for at least 30 s or requiring defibrillation were analyzed. All documented pre- and post-LVAD sustained ventricular arrhythmias were classified either as monomorphic ventricular tachycardia (MVT) or polymorphic ventricular tachycardia (PVT)/ventricular fibrillation (VF).

Our population had an average age of 51 years, had predominately ischemic cardiomyopathy (63%), and a mean left ventricular ejection fraction of 20 +/- 10%. New-onset MVT was observed in 18 patients who did not have MVT before LVAD placement. After LVAD, new-onset MVT was 4.5 times more likely than elimination of previously present MVT (p = 0.001), whereas the effect of LVAD on incidence of PVT/VF was not significant. In a multivariate Cox proportional hazards regression analysis, serum electrolyte abnormality was an independent predictor of post-LVAD ventricular arrhythmias. Preoperative MVT did not predict postoperative MVT.

After LVAD placement, there is a significant rise in the incidence of de novo MVT. By contrast, the incidence of PVT/VF was unaffected by LVAD placement.