Abstract 10866: Effect of Preoperative Atrial Fibrillation on Outcomes After Left Ventricular Assist Device Implantation

Abstract

Introduction: Although preoperative atrial fibrillation (AF) is common in patients undergoing left ventricular assist device (LVAD) implantation, how AF affects clinical outcomes remains unclear. Objectives: We aimed to assess the safety and efficacy of LVAD implantation in AF patients Methods: Statistical analysis was performed using meta-package for R version 4.0 and Rstudio version 1.2. Mantel Haenszel Odds ratio (OR) random effects model (DerSimonian and Laird method) was used to summarize data. Outcomes studied were - (1) all-cause mortality; (2) systemic thromboembolism; (3) stroke (ischemic and hemorrhagic); (4) pump thrombosis; (5) gastrointestinal (GI) bleed. Results: Nine retrospective studies with a total of 6,782 patients (AF=2,170 and non-AF =4,612) were included in analysis. When compared with non-AF group, AF group patients were older (57.9±2.9 vs 52.2±5.8 years, p<0.001) and had less proportion of patients with INTERMACS profile 1, 2 (50.2% vs 54.3%, p<0.001). Preoperative AF was not associated with increased risk of all-cause mortality at 6 months (OR 1.20,95% 0.91-1.57, p=0.19), 12 months (OR 1.35, 95% CI 0.74-2.47, p=0.33) and 24 months (OR 1.23, 95% CI 0.95-1.60, p=0.12). Preoperative AF did not increase the risk of thromboembolism (OR 1.04, 95% CI 0.75-1.43, p=0.81), stroke (OR 0.89, 95% CI 0.74-1.08, p=0.24), and pump thrombosis (OR 1.28, 95% CI 0.97-1.70, p=0.08) after LVAD implantation. However, AF was associated with increased risk of GI bleeding (OR 1.28, 95% CI 1.12-1.47, p<0.001) [median follow up 11.5 months (9.6, 24)]. Conclusion: Our study demonstrates a significantly increased risk of GI bleeding in LVADs recipients with concomitant AF, with no significant effect on all-cause mortality, stroke, or thromboembolic events (likely driven less sick patient population in AF group).