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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.
Abstract:
Right ventricular (RV) failure is a significant complication in left ventricular assist devices (LVADs). The optimal pacing mode and its impact on RV function and clinical outcomes remain unclear. We retrospectively analyzed HeartMate3 patients at our center between 2014 and 2023, categorizing to biventricular (BiV), RV, and no/limited pacing (<50% pacing). Outcomes included RV function, survival, late RV failure, hemocompatibility-related adverse event (HRAE), and ventricular arrhythmias (VA). We included 359 patients (age 60; 84.7% male, 57.2% nonischemic cardiomyopathy), 23.9% BiV, 8.8% RV, and 67.3% no/limited pacing. Post-LVAD echocardiographic and invasive hemodynamic assessments revealed no significant differences in RV function. Ventricular arrhythmia episodes were more frequent in the BiV (23.9%) and RV (23.1%) compared with the no/limited pacing (8.0%) (p = 0.001). Two-year survival was similar between the RV (96.2%) and no/limited pacing (96.1%), but lower in the BiV (87.3%, p = 0.042). Survival free of late RV failure was highest in the no/limited pacing (p = 0.003), as was survival free of the composite outcome (late RV failure, HRAE, and VA) (p = 0.012). Pacing, irrespective of mode, did not impact RV hemodynamics in this cohort. Patients with no pacing/low pacing burden had a lower incidence of VA and improved survival free of RV failure. Patients with BiV pacing had the worst overall survival.
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