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Published on: June 12, 2021
Evaluation of cardiac arrhythmia in pediatric patients with Left Ventricular Assist Device (L-VAD)
1Department of Pediatrics, Division of Pediatric Cardiology, Faculty of Medicine, Ege University, İzmir, Türkiye. eserdogan86@hotmail.com.
Insights
Pediatric heart failure patients receiving a left ventricular assist device (L-VAD) frequently develop arrhythmias. Medical therapy is recommended before cardioversion or defibrillation for these rhythm disturbances.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Medical Devices
Background:
- Pediatric heart failure significantly impacts child morbidity and mortality.
- Left ventricular assist devices (L-VADs) serve as a crucial bridge to transplantation for pediatric patients with end-stage heart failure.
Purpose of the Study:
- To investigate the incidence and characteristics of arrhythmias in pediatric patients following L-VAD implantation.
- To evaluate the management strategies for rhythm disturbances in this patient population.
Main Methods:
- Retrospective analysis of 33 pediatric patients who underwent L-VAD implantation for advanced heart failure between January 2009 and January 2023.
- Detailed review of patient demographics, echocardiographic findings, and electrocardiogram (ECG) data, including pre- and post-L-VAD arrhythmias.
- Classification of arrhythmias into atrial and ventricular types, with analysis of treatment interventions.
Main Results:
- The study included 33 pediatric patients (48.5% female, 51.5% male) with a median age of 13 years.
- Dilated cardiomyopathy was the echocardiographic diagnosis in all patients.
- Arrhythmias were observed in 33% of patients post-L-VAD implantation, with atrial arrhythmias becoming more frequent after surgery compared to ventricular arrhythmias pre-surgery.
- Five patients required cardioversion or defibrillation for arrhythmia management.
Conclusions:
- Pediatric patients undergoing L-VAD implantation are prone to significant rhythm disorders.
- Medical management should be prioritized for these arrhythmias before considering cardioversion or defibrillation.
- Aggressive treatment strategies may be necessary for refractory arrhythmias post-L-VAD implantation.
Objective:
Pediatric heart failure is an important cause of morbidity and mortality in childhood. Left ventricular assist devices (L-VAD) are used for bridging to transplantation in patients with indications for heart transplantation.
Patients And Methods:
The children included in the study were patients who underwent implantation of an L-VAD due to advanced heart failure at Ege University Faculty of Medicine Hospital between January 2009 and January 2023.
Results:
Of the 33 patients who underwent L-VAD implantation, 16 (48.5%) were female and 17 (51.5%) were male. The median age at surgery was 13 years (IQR, 9.5-15). The median weight was 44 kg (IQR, 25.65-52), the median height was 158 cm (IQR, 134.5-168.5), and the median body surface area was 1.37 m2 (IQR, 0.95-1.51). All patients who underwent L-VAD implantation had an echocardiographic diagnosis of dilated cardiomyopathy. The patients underwent a median of 16 (IQR, 9-21) ECGs, and the median number of 24-hour Holter ECGs obtained was 3 (IQR, 2-5). Arrhythmias that occurred after L-VAD implantation were classified as atrial and ventricular. Ventricular arrhythmia included ventricular tachycardia (VT) lasting for more than 30 seconds (sustained VT), VT lasting for less than 30 seconds (nonsustained VT), and ventricular fibrillation. Atrial arrhythmias included atrial flutter, atrial fibrillation, supraventricular tachycardia, and atrial ectopic tachycardia. During the follow-up, atrial or ventricular arrhythmias were observed in 11 (33%) patients. The most common rhythm disturbances before L-VAD implantation were ventricular arrhythmias, while after the surgery, atrial arrhythmias were found to be the most frequent. A total of 5 patients underwent cardioversion (n=2) or defibrillation (n=3) due to arrhythmia.
Conclusions:
In patients undergoing L-VAD implantation, rhythm disorders that could normally lead to hemodynamic instability are frequently encountered. In these rhythm disorders, medical therapy should be attempted before resorting to cardioversion or defibrillation, and subsequently, more aggressive treatment methods should be considered.
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