Association Of Pre-LVAD ICD Shocks With Post-LVAD Outcomes

Abstract

<h3>Background</h3> Ventricular arrhythmias (VAs) are a common complication of advanced heart failure (1-3). Patients treated with left ventricular assist devices (LVADs) generally tolerate VAs better than unsupported patients, however ICD shocks after LVAD are associated with poor quality of life and may be associated with increased mortality (4,5). Little is known regarding the association of pre-LVAD ICD shocks on post-LVAD clinical outcomes. We sought to determine if pre-LVAD ICD shocks are associated with adverse clinical outcomes and to compare the incidence of pre-LVAD shocks to post-LVAD shocks. <h3>Methods</h3> All patients 18 years or older with continuous flow LVADs were retrospectively identified within the UPMC system from 2006-2020. We analyzed the association between ICD shocks within one year pre- and post-LVAD with one-year clinical outcomes including post-LVAD appropriate ICD shock, death, stroke, pump thrombosis, heart transplant, and CHF hospitalization. Analyses were adjusted for baseline demographics and comorbidities. <h3>Results</h3> Among 309 individuals, average age was 57±12 years, 87% were male, 80% had ischemic cardiomyopathy, and 42% were implanted as a bridge to transplantation. Average INTERMACS score was 2.3. A total of 71 (23%) experienced pre-LVAD shocks and 69 (22%) experienced post-LVAD shocks. The percentage of those treated pre- and post-LVAD with antiarrhythmics was 37% and 80%, respectively. Pre-LVAD ICD shocks were found to predict post-LVAD shocks (p<0.001) and post-LVAD CHF admission (p=0.02). Pre-LVAD shocks were not associated with the composite outcome of death, stroke, pump thrombosis, and heart transplantation. Post-LVAD shocks were not associated with the composite outcome of death, stroke, pump thrombosis, or heart transplant nor with admission for CHF. The incidence of shocks pre-LVAD was not different than the incidence post-LVAD. <h3>Conclusions</h3> Pre-LVAD ICD shocks predicted post-LVAD ICD shocks but were not associated with the composite outcome of death, pump thrombosis, stroke, or heart transplant at one year. LVAD placement did not affect the incidence of ICD shocks in patients requiring LVAD therapy. Alternative approaches such as surgical ablation for arrhythmias may have a role in this population.