Comparison of Amiodarone and Beta Blockers to Suppress Tachyarrhythmias in Patients with Left Ventricular Assist Devices

Abstract

Purpose We evaluated the role of amiodarone (AMI) and beta blockers (BB) in reducing the number of tachyarrhythmia events or related readmissions in patients with left ventricular assist devices (LVAD). Methods All patients that received a continuous-flow LVAD at a single center between 2011-2017 were retrospectively reviewed. Patients were separated into 4 groups including AMI only, BB only, both, or neither at time of LVAD implantation and 1 month, 6 months, or 12 months post-LVAD. Primary outcomes included number of tachyarrhythmia events (greater than 30 seconds or requiring cardioversion) between intervals 0-1 month, 1-6 months, and 6-12 months and readmissions due to arrhythmia at 12 months. Analysis involved ANOVA to compare the mean number of arrhythmia events between these time intervals with the 4 groups being determined by type of therapy at the beginning of each interval. Results A total of 111 patients were included in this study, including 27 (24.3%) females. The mean age was 60.5 (SD ± 12.3) years and mean BMI was 30.4 (SD ± 7.4) kg/m2. The BB only group included 0 (0%) patients at time of LVAD, 18 (16.3%) at 1 month, 31 (37.5%) at 6 months, and 27 (38.2%) at 12 months. The AMI only group included 53 (47.7%) at time of LVAD, 33 (33.6%) at 1 month, 10 (12.5%) at 6 months, and 8 (11.8%) at 12 months. The BB + AMI group included 1 (0.9%) at time of LVAD, 33 (33.7%) at 1 month, 33 (41.3%) at 6 months, and 27 (39.7%) at 12 months. Neither BB or AMI was used in 57 (51.3%) at time of LVAD, 14 (14.3%) at 1 month, 6 (7.5%) at 6 months, and 6 (8.8%) at 12 months. At 1 month, mean number of arrhythmia events was 1.7 with AMI only, 6.0 with BB + AMI, and 1.0 with neither (P = 0.02). Between 1 - 6 months post-LVAD, mean number of events was 7.7 with BB only, 0.5 with AMI only, 0.7 in BB + AMI, and 0.4 with neither (P = 0.27). Between 6 - 12 months, mean number of events was 0.1 with BB only, 0 with AMI only, 1.4 AMI + BB, and 0 with neither (P = 0.60). Mean number of readmissions at 12 months was greatest in group with BB + AMI at 6 months (BB only, 0.03; AMI only, 0; BB + AMI, 0.36; neither, 0; P = 0.04). Conclusion In this retrospective analysis, the use of AMI and/or BB did not appear to reduce the burden of tachyarrhythmias in patients with LVAD, and the use of both was associated with the highest number of readmissions. Prospective studies are needed to evaluate the efficacy of anti-arrhythmic therapies in these patients.