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Predictors and Clinical Impact of Late Ventricular Arrhythmias in Patients With Continuous-Flow Left Ventricular
Vincent Galand1, Erwan Flécher2, Vincent Auffret1
1Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France; Université de Rennes 1, Rennes, France; U1099, INSERM, Rennes, France.
Insights
Late ventricular arrhythmias (VAs) are common after left ventricular assist device (LVAD) implantation. A new VT-LVAD score can help identify patients at risk and guide implantable cardioverter-defibrillator (ICD) decisions.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- The risk of arrhythmias and the need for implantable cardioverter-defibrillators (ICDs) in patients with left ventricular assist devices (LVADs) are not well understood.
- Late ventricular arrhythmias (VAs) can significantly impact patient outcomes after LVAD implantation.
Purpose of the Study:
- To evaluate the incidence, clinical impact, and predictors of late VAs in LVAD recipients.
- To clarify the indications for ICDs in LVAD patients.
- To develop a risk stratification tool for late VAs.
Main Methods:
- An observational study involving 659 LVAD recipients across 19 centers (2006-2016).
- Late VAs defined as sustained ventricular tachycardia or fibrillation >30 days post-LVAD, requiring intervention.
- Multivariable analysis to identify independent predictors of late VAs.
Main Results:
- Late VAs occurred in 26.9% of patients.
- Six independent predictors of late VAs were identified, including prior VAs, atrial fibrillation, cardiomyopathy etiology, heart failure duration, early VAs, and medication use.
- A "VT-LVAD score" was developed, stratifying patients into risk groups with 1-year VA rates ranging from 0% to 55%.
Conclusions:
- Late VAs are a frequent complication following LVAD implantation.
- The VT-LVAD score effectively identifies patients at high risk for late VAs.
- This score can aid in guiding ICD implantation decisions for LVAD patients.
Objectives:
This study aimed to evaluate the incidence, clinical impact, and predictors of late ventricular arrhythmias (VAs) in left ventricular assist device (LVAD) recipients aiming to clarify implantable cardioverter-defibrillator (ICD) indications.
Background:
The arrhythmic risk and need for ICD in patients implanted with an LVAD are not very well known.
Methods:
This observational study was conducted in 19 centers between 2006 and 2016. Late VAs were defined as sustained ventricular tachycardia or fibrillation occurring >30 days post-LVAD implantation, without acute reversible cause and requiring appropriate ICD therapy, external electrical shock, or medical therapy.
Results:
Among 659 LVAD recipients, 494 (median 58.9 years of age; mean left ventricular ejection fraction 20.7 ± 7.4%; 73.1% HeartMate II, 18.6% HeartWare, 8.3% Jarvik 2000) were discharged alive from hospital and included in the final analysis. Late VAs occurred in 133 (26.9%) patients. Multivariable analysis identified 6 independent predictors of late VAs: VAs before LVAD implantation, atrial fibrillation before LVAD implantation, idiopathic etiology of the cardiomyopathy, heart failure duration >12 months, early VAs (<30 days post-LVAD), and no angiotensin-converting enzyme inhibitors during follow-up. The "VT-LVAD score" was created, identifying 4 risk groups: low (score 0 to 1), intermediate (score 2 to 4), high (score 5 to 6), and very high (score 7 to 10). The rates of VAs at 1 year were 0.0%, 8.0%, 31.0% and 55.0%, respectively.
Conclusions:
Late VAs are common after LVAD implantation. The VT-LVAD score may help to identify patients at risk of late VAs and guide ICD indications in previously nonimplanted patients. (Determination of Risk Factors of Ventricular Arrhythmias [VAs] after implantation of continuous flow left ventricular assist device with continuous flow left ventricular assist device [CF-LVAD] [ASSIST-ICD]; NCT02873169).
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