Abstract
In this retrospective single-center trial, we analyze 109 consecutive patients (female: 27.5%, median age: 69 years, median left ventricular ejection fraction: 20%) who survived sudden cardiac death (SCD) and needed hemodynamic support from an Impella assist device between 2008 and 2018. Rhythm monitoring is investigated in this population and associations with hospital survival are analyzed. Hospital mortality is high, at 83.5%. Diverse cardiac arrhythmias are frequently registered during Impella treatment. These include atrial fibrillation (AF, 21.1%) and ventricular tachycardia (VT, 18.3%), as well as AV block II°/III° (AVB, 7.3%), while intermittent asystole (ASY) is the most frequently observed arrhythmia (42.2%). Nevertheless, neither ventricular nor supraventricular tachycardias are associated with patients’ survival. In patients who experience intermittent asystole, a trend towards a fatal outcome is noted (p = 0.06). Conclusions: Mortality is high in these severely sick patients. While cardiac arrhythmias were frequent, they did not predict hospital mortality in this population. The hemodynamic support of the pump seems to counterbalance the adverse effects of these events.
Highlights
The indication for Impella support was determined by a systolic blood pressure below 90 mmHg for more than 30 min, a highly decreased left ventricular ejection fraction (LVEF) of less than 30%, the presence of elevated serum lactate values > 2 mmol/L or continuous hemodynamic instability despite inotrope or vasopressor therapy
A total of 87 (79.8%) patients presented with acute myocardial infarction (AMI), while 61.5% of our patients received a coronary angiography and stent implantation, if adequate (Table 1)
Bradyarrhythmias were revealed with a high rate of intermittent ASY (42.2%)
Summary
Survivors of SCD are often critically ill and need ventricular assist device support due to systemic hypotension and tissue hypoperfusion. Mortality is high among survivors of SCD with the need for an assist device, and the therapy with an Impella has a controversial impact on survival [5], while bearing the potential for sometimes severe complications [6]. Since SCD is caused by the onset of severe cardiac arrhythmias we, hypothesized that their occurrence throughout the course of treatment, even in the presence of a potent blood pump, could be a predictor of impaired survival. We analyzed survivors of SCD treated with an Impella at our hospital with regard to the occurrence and classification of various types of arrhythmias.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
