CE-452777-1 INCIDENCE, PREDICTORS AND CLINICAL SIGNIFICANCE OF LATE VENTRICULAR ARRHYTHMIAS AFTER LVAD IMPLANTATION

Abstract

Long-term survival after durable left ventricular assist device (LVAD) is improving. Ventricular arrhythmias are a driver of patient morbidity following implantation. Predictors of late ventricular arrhythmias (LVA) and their prognostic significance remain uncertain. We sought to determine the incidence of LVA, risk factors associated with their development and their clinical impact on patients in patients after LVAD implantation in long-term follow-up. A single-center retrospective analysis was performed including patients who underwent LVAD implantation from 2007-2022. We compared clinical characteristics and outcomes between patients who developed LVA to those patients without LVA. LVAs were defined as an episode of sustained ventricular tachycardia or ventricular fibrillation identified on ECG, telemetry and/or CIED occurring >30 days after LVAD implantation. Transplant-free survival was defined as time from index LVAD implantation to transplantation, LVAD explantation, death or most-recent follow-up. Of the 788 patients who underwent LVAD implantation during the study period, 141 patients (21.9%) had LVA >30 days after LVAD implantation. There was no significant difference between ages of patients with LVA and those without ventricular arrhythmia following LVAD implantation (LVA vs no LVA: 63.2 vs 62.3 years; p = 0.556). The majority of patients were male (78.7% vs 71.8%; p = 0.102) and self-identified as black (70.9% vs 71.8%; p = 0.875). Patients with LVAs more often had a history of preoperative presence of CRT (22.9% vs 12.5%; p = 0.002), history of ventricular tachycardia (49.3% vs 30.0%; p = <0.001), history of atrial flutter ablation (10.7% vs 3.7%; 0.001), appropriate ICD therapy prior to implantation (15.7% vs 5.5%; p = <0.001), taking amiodarone (31.8% vs 21.9%; p = 0.023), larger LVEDD (7.0 cm ± 1.0 vs 6.8 cm ± 1.0; p = 0.013) and QTc prolongation (504.8 ms ± 56.5 vs 518.2 ms ± 50.3; p = 0.017). The strongest independent predictors of LVA were a history of atrial flutter ablation (OR 3.52; CI 1.43-8.62; p = 0.006) and appropriate ICD shock in 7 days prior to implantation (OR 3.22; CI 1.49-6.99; p = 0.003). There was no difference between transplant-free survival time in patients with and without LVAs (p = 0.062, Figure 1). Despite being a common event after LVAD therapy, the development of LVA does not adversely impact transplant-free survival time. Future studies are warranted to determine the impact of LVA on quality-of-life in LVAD patients.