0376: Arrhythmic storm in patients with Heart Mate® II. Incidence, risk factors and management

Abstract

Rhythmic complications seem common after left ventricular (LV) assist device (LVAD), especially in the early phase of implantation (<30 days). We sought to identify the incidence and risk factors of arrhythmic storm occuring after Heart Mate ® 2 (HM2) implantation. All patients with HM2 implanted in our institution have been studied. Clinical data, occurrence of arrythmia, implantable cardioverter-defibrillator (ICD), ultrasound parameters as well as follow-up have been analyzed. From January 2008 to April 2013, 33 patients ( 30 men, 58±10 years, LVEF 20 ±5% , ischaemic cardiomyopathy 82%, 70% bridge to transplant), were included. Before implantation, 15 had ICD (12 for primary prévention) and 11 had a history of sustained ventricular tachycardia (VT). The overall mortality rate was 48% with a mean follow-up of 11±11 months. Post-LVAD arrhythmic storm (10 patients, including 9 in the first 30 days) were more frequent in patients with prior VT ( 70% vs 17%, p<0.01 ), prior ICD ( 80% vs 30%, p=0.01 ), larger LV end diastolic diameter ( 77±9 vs 67±6 mm, p=0.02 ) and non ischaemic cardiomyopathy ( 40 vs 8%, p=0.053 ). Arrhythmic storm occuring just prior LVAD implantation (8 patients) was not associated with arrhythmic storm recurrence after. Endocardial VT ablation was performed in 6. The substrate was not related to HM2 cannula. Arrhythmic storm are frequent ( 33% ) after HM2 implantation, often occurring within one month in patients with prior VT episode.