PO-05-063 MORTALITY IN LEFT VENTRICULAR ASSIST DEVICE RECIPIENTS WITH VT REQUIRING ABLATION

Abstract

Left Ventricular Assist Devices (LVADs) improve survival in patients with heart failure. However, an increased burden of ventricular tachycardia (VT) can occur following LVAD implantation. The role of ablation in the treatment of VT for LVAD recipients and the timing of when ablation should occur is unclear. To determine mortality in LVAD recipients with VT who required an ablation We retrospectively reviewed all patients who received a ventricular ablation from January 2014 to February 2021 and included those who underwent VT ablation after LVAD placement. The composite endpoints included transplant, lost to follow up, or last date of data collection. Event failure was defined as patient death. Survival rates were calculated with Kaplan-Meier analysis. Rate of event failure was calculated as per patient-year incident death rate (IR) and was compared between treatment groups by incident rate ratio with 95% confidence intervals (IRR [95% CI]). Survival analysis was performed using STATA. 36 patients underwent VT ablation after LVAD placement. Of those, 21 (58%) had documented VT prior to LVAD placement and 14 (42%) had de novo VT after LVAD placement. Within 30 days, one patient died (IR 0.339 over 2.95 patient-years); within one year, four patients died (IR 0.128 over 31.1 patient-years); within two years, ten patients died (IR 0.183 over 54.5 patient-years); and within eight years, twenty patients died (IR 0.217 over 92.2 patient-years). At a study endpoint of 2 years (the time interval between the most recent LVAD placement and the last date of data collection), a significantly higher death rate per patient-year was found in patients with VT onset within 7 days of LVAD placement (IRR 5.19 [1.08-21.87]), with a trend towards significantly higher death rate seen in patients with ischemic cardiomyopathy (ICM) (IRR 4.12 [0.82-39.9]) (Table 1). All patients who died underwent a VT ablation within 90 days of VT onset (Figure 1). Mortality in LVAD recipients was highest in the immediate post-operative period, especially when VT occurred within 7 days of LVAD placement. A higher death rate was also seen when ablation was performed within 90 days of VT onset. Further comparison to matched LVAD recipients without VT requiring ablation is needed to better understand the impact of VT on mortality in LVAD recipients.Tabled 1Table 1. IRRs of Patient Mortality Stratified by Presence or Absence of Specific Risk FactorsAbsentPresentIRR95% CIp-valueIschemic Cardiomyopathy0.0720.2984.12[0.82-39.9]0.059LVAD as Destination Therapy0.1100.2572.32[0.53-13.93]0.223HeartWare LVAD Placed0.1450.2241.55[0.37-7.47]0.516VT Prior to LVAD Placement0.1150.2462.14[0.49-12.80]0.283VT Ablation Prior to LVAD Placement0.2020.1680.83[0.14-3.64]0.825VT Within 7 Days of LVAD Placement0.1240.6455.19[1.08-21.87]0.023Ablation of VT Within 90 Days of VT Onset00.260------0.031Multiple Ablations Performed for Recurrent VT0.2180.0760.35[0.08-2.50]0.322 Open table in a new tab