Impact of Atrial Fibrillation on Mortality and Thromboembolic Complications after Left Ventricular Assist Device Implantation

Abstract

Purpose Atrial fibrillation (AF) is a known risk factor for thromboembolic complications. However, there is paucity of large-scale data on its influence on outcomes in patients undergoing left ventricular assist device (LVAD) implantation. Methods Using the National Inpatient Sample, we identified patients who underwent LVAD implantation from 2010-2014. Multivariate logistic regression was used to evaluate the impact of AF on in-hospital outcomes. Results A total of 15,483 patients (40.68% with AF) underwent LVAD implantation. Patients with AF were older (59.7 vs 54.2 years), more commonly male (80 vs 73.8%), and had a greater burden of comorbidities (Elixhauser 7.1 vs 6.2). Compared to patients without AF, patients with AF had lower in-hospital mortality (9.6 vs 15.3%; OR 0.49; p Conclusion AF is common in LVAD recipients but is not associated with increased mortality, thromboembolic or bleeding complications during the index admission for LVAD placement. Patients with known AF are typically chronically anticoagulated, possibly related to less early thromboembolic events. Further studies analyzing the differences between these two groups in more detail, including anticoagulation strategies in AF patients and possible confounding clinical and/or echocardiographic variables, are warranted to understand the potential decreased risk of patients with AF found in this cohort.