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Does Pacemaker Mode Affect Outcomes in Patients With HeartMate 3 LVAD?
Boaz Elad1, Dor Lotan1, Brian LaBarre1
1From the Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons and NewYork-Presbyterian Hospital, New York, New York.
Pacing mode after left ventricular assist device (LVAD) implantation does not affect right ventricular (RV) function. However, biventricular pacing is linked to worse survival and higher ventricular arrhythmias.
Area of Science:
- Cardiology
- Mechanical Circulatory Support
- Heart Failure Management
Background:
- Right ventricular (RV) failure is a critical complication following left ventricular assist device (LVAD) implantation.
- The optimal pacing strategy to mitigate RV complications remains undetermined.
Purpose of the Study:
- To investigate the impact of different pacing modes (biventricular, RV-only, and no/limited pacing) on RV function and clinical outcomes in HeartMate3 LVAD patients.
Main Methods:
- Retrospective analysis of 359 HeartMate3 LVAD patients from 2014-2023.
- Categorization into biventricular (BiV), RV pacing, and no/limited pacing groups.
- Assessment of RV function, survival, late RV failure, hemocompatibility-related adverse events (HRAE), and ventricular arrhythmias (VA).
Main Results:
- No significant differences in RV function were observed across pacing groups.
- Ventricular arrhythmias (VA) were significantly more frequent in BiV and RV pacing groups compared to no/limited pacing (23.9% and 23.1% vs. 8.0%, p=0.001).
- Two-year survival was lower in the BiV group (87.3%) compared to RV (96.2%) and no/limited pacing (96.1%) (p=0.042).
- Survival free of late RV failure and a composite outcome (late RV failure, HRAE, VA) was highest in the no/limited pacing group (p=0.003 and p=0.012, respectively).
Conclusions:
- Pacing mode does not influence RV hemodynamics post-LVAD.
- Minimizing pacing burden is associated with reduced VA and improved survival free of RV failure.
- Biventricular pacing is associated with poorer overall survival in LVAD patients.
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