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Incidence, Predictors, and Significance of Ventricular Arrhythmias in Patients With Continuous-Flow Left Ventricular

Brian D Greet1, Deep Pujara1, David Burkland1

  • 1Division of Cardiology, Baylor College of Medicine, Houston, Texas.

JACC. Clinical Electrophysiology
|May 12, 2018
PubMed

Insights

Early ventricular arrhythmias (VAs) after continuous-flow left ventricular assist device (CFLVAD) implantation increase mortality risk. Prior cardiac surgery and VT storm predict early VAs, with incidence decreasing over time.

Area of Science:

  • Cardiology
  • Medical Devices
  • Arrhythmia Research

Background:

  • Ventricular arrhythmias (VAs) are common in patients with left ventricular assist devices (LVADs).
  • Limited data exist on the prognostic impact of VAs in contemporary continuous-flow LVADs (CFLVADs).

Purpose of the Study:

  • To evaluate the incidence, predictors, and mortality associated with pre-implantation, early, and late VAs in CFLVAD recipients.
  • To analyze the prognostic significance of VAs in the context of modern CFLVAD therapy.

Main Methods:

  • Retrospective review of 517 patients undergoing CFLVAD implantation (2000-2015) with 2-year follow-up.
  • Analysis of all VAs, including ventricular fibrillation and sustained ventricular tachycardia.
  • Definition of early VAs as those occurring within 30 days post-implantation.

Main Results:

  • Early VAs significantly reduced survival (HR: 1.83; p=0.001) compared to late or no VAs.
  • Predictors of early VAs included prior cardiac surgery (OR: 1.90; p=0.023) and pre-CFLVAD VT storm (OR: 3.15; p=0.003).
  • Incidence of early VAs decreased from 47% (2000-2007) to <22% (2008-2015).

Conclusions:

  • Early VAs post-CFLVAD implantation are linked to increased mortality risk.
  • Prior cardiac surgery and pre-CFLVAD VT storm are key predictors of early VAs.
  • A decreasing temporal trend in VA incidence suggests potential for improved management strategies.
Abstract

Keywords:
cardiac arrhythmiacontinuous-flow left ventricular assist deviceleft ventricular assist deviceventricular arrhythmiaventricular fibrillationventricular tachycardia

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