Abstract
Atrial fibrillation (AF) is common in patients with the left ventricular assist device (LVAD), but the little is known about the impact of AF on clinical outcomes. The aim of this study is to investigate the impact of AF on outcomes in patients with the HeartMate 3 (HM3) LVAD. We retrospectively reviewed 113 patients (December 2014 to June 2018) who underwent HM 3 implantation at Columbia University Medical Center. We divided patients into 3 cohorts: no AF, paroxysmal AF (PAF), or persistent AF (PeAF). The primary endpoint was a death at 2-year and a composite of death and hospital readmission due to recurrent heart failure, stroke, and gastrointestinal bleeding. AF was present in 61 patients (54%). Forty-three (38%) patients had PAF and 18 (16%) patients had PeAF at the time of LVAD implantation. Patients with PeAF were more likely to be older and have larger left atrial dimension. Patients with PAF or PeAF had higher incidence of perioperative right heart ventricular assist device support compared to patients with no AF (P=0.03). Kaplan-Meier analysis showed that patients with PeAF were significantly worse survival at 2-years (PeAF 65%, PAF 93%, no AF 93%, P=0.007). Composite event at 2-year occurred in 54% in PeAF, 75% in PAF, 69% in no AF (P=0.049). PeAF was associated with significantly worse clinical outcomes in patients with the HM 3 LVAD. Patient undergoing HM 3 may require additional intervention to reduce AF burden.
Published Version
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