Abstract
Background: Ventricular arrhythmias (VAs) are common in patients with left ventricular assist devices (LVADs). Little is known about the impact of third-generation LVADs (Heartmate 3, HM3) on VAs prevalence and burden. Aims : To characterize the impact of HM3 LVAD implantation on VAs prevalence and burden in patients with advanced heart failure (HF) and implantable cardioverter-defibrillators (ICDs). Methods: We included consecutive patients with advanced HF and ICDs who received HM3 devices at our center between 2016 and 2022. The study outcomes were the prevalence of sustained VAs, defined as >30s VA episode detected by the ICD monitor zone or appropriately treated (ATP or shock), sustained VA burden (total number of episodes), and VA storm (≥3 appropriate ICD interventions in 24/h period). Data was collected over the 1 year before and after HM3 implantation. Results: A total of 321 patients were included (28% female, mean age 60±12 years, mean INTERMACS score 3±0.95). At 1 year follow-up after HM3 implantation, 27 patients died. A total of 128 patients (43%) had at least one sustained VA episode in the year before the HM3 implantation compared to 51 patients (17%) in the year following the HM3 (p<0.001 for comparison). The sustained VA burden decreased from a mean of 3.8 events per person-year (PPY) to a mean of 0.8 events PPY (p=0.005). Similarly, appropriate ICD therapy occurred in 123 patients (38%) before implantation and 46 patients (14%) after implantation (p<0.001). The burden of appropriate therapy was also reduced (from a mean of 2.57 events PPY to a mean 1.32 events PPY; p=0.03). The prevalence of VA storm was reduced from 19% to 8% (p<0.001). Conclusions: In patients with advanced HF and ICDs undergoing HM3 implantation, the prevalence of sustained VAs, VAs burden, appropriate ICD interventions, and VA storm were all significantly reduced in the year following HM3 implantation.
Published Version
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