Abstract
The association between ventricular arrhythmias (VAs) and mortality in patients supported by continuous flow left ventricular assist devices (LVAD) remains controversial. To evaluate the association between pre-implantation, early (≤ 30 day) post-implantation VAs and mortality in bridge to transplant (BTT) and destination therapy (DT) LVAD patients, separately. The risk factors for post LVAD VAs were also investigated. In this observational cohort study, we included 341 patients who received a first time, continuous flow LVAD between January 1st 2010 and July 30th 2018. We used Kaplan–Meier curves and multivariable cox regression analyses to study the association between VAs and mortality in the BTT and DT populations. The mean age of the cohort was 58 ± 14 years, with 82% males, 53% had ischemic cardiomyopathy, and 45% were DT. The mean follow-up was 2.2 ± 2.1 years. In both BTT and DT cohorts, pre LVAD VAs were not associated with mortality after LVAD implantation (log-rank p = 0.95 and p = 0.089, respectively). In the BTT population, early post-LVAD VAs were not statistically associated with increased mortality (log rank p = 0.072). In the DT patients, early post LVAD VAs were associated with a 67% increase in the hazards rate of mortality on LVAD support (HR 1.67 [1.05–2.65], p = 0.029). The final model was adjusted for type of cardiomyopathy, INTERMACS profile, glomerular filtration rate, post LVAD atrial fibrillation, age and cerebrovascular events. Early post-LVAD VA is common after LVAD implantation and is an independent predictor of mortality in the DT LVAD population.
Highlights
Abbreviations atrial fibrillation (AF) Atrial fibrillation ATP Anti-tachycardia pacing bridge to transplant (BTT) Bridge to transplant destination therapy (DT) Destination therapy implantable cardioverter defibrillator (ICD) Implantable cardioverter defibrillator INTERMACS Interagency Registry for Mechanically Assisted Circulatory Support left ventricular assist devices (LVAD) Left ventricular assist device LV Left ventricle/left ventricular LVEF Left ventricular ejection fraction ventricular arrhythmias (VAs) Ventricular arrhythmias
The mean age of the cohort was 58 ± 14 years, 82% were male, 53% had ischemic cardiomyopathy, and 45% were designated as DT at the time of LVAD implantation
Pre-LVAD VAs were present in 51% of the entire cohort and early post LVAD VAs occurred in 37% of patients, respectively
Summary
Abbreviations AF Atrial fibrillation ATP Anti-tachycardia pacing BTT Bridge to transplant DT Destination therapy ICD Implantable cardioverter defibrillator INTERMACS Interagency Registry for Mechanically Assisted Circulatory Support LVAD Left ventricular assist device LV Left ventricle/left ventricular LVEF Left ventricular ejection fraction VAs Ventricular arrhythmias. Since the UNOS allocation system change in October of 2018 in the United States, newly implanted LVAD patients are more likely to be destination therapy (DT), and the existing bridge to transplant (BTT) patients are facing longer times on LVAD support[2]. This raises the importance of understanding the risk of preexisting VAs and the clinical significance of post LVAD Vas in both patient populations. The risk factors for post LVAD VAs were investigated
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