The Effect Of Milrinone Therapy On Ventricular Arrhythmias In Patients With Advanced Heart Failure

Abstract

Background Milrinone is a commonly used inotrope due to favorable hemodynamic effects in patients with advanced HF. The effect of Milrinone on ventricular arrhythmias has not been completely defined. Objective The aim of this study was to assess the effect of IV chronic Milrinone therapy on the burden of ventricular arrhythmias. Method In this single-center, retrospective analysis, data from 75 consecutive patients who underwent Milrinone therapy for symptomatic advanced heart failure from 11/2017 to 9/2019 were reviewed. Those with complete follow up and device interrogation prior and after Milrinone initiation were included in the study. CRM remote monitoring data was used to obtain the burden of ventricular arrhythmias and baseline clinical parameters including medications and echocardiographic data were retrospectively abstracted from EMRs. Results A total of 28 patients were included in the study (Average Age=67±17 years, 89% Male, Baseline LVEF=22±7%, ICM 43%). Using remote monitoring data, the daily average burden of sustained VT/VF, NSVT, ICD shocks/ATP therapy and total ventricular arrhythmias in the 6-month period prior to Milrinone initiation were 0.004±0.002, 0.05±0.02, 0.0004±0.0003 and 0.05±0.02 episodes, respectively. Patient received Milrinone therapy (Mean Dose=0.44±0.02 mcg/kg/min) and during the follow-up period while receiving Milrinone (Mean follow-up 214±26 days), the daily average burden of sustained VT/VF, NSVT, ICD shocks/ATP therapy and total ventricular arrhythmias more than doubled and were 0.009±0.008, 0.12±0.05, 0.001±0.0006 and 0.13±0.06 episodes, respectively. From univariate regression analysis, only the average dose of Milrinone was associated with increased burden of ventricular arrhythmias (R2=0.16, P=0.034). Conclusion This study demonstrated an increase in the total burden of NSVT and Sustained VT and VF as well as Total Burden of ICD Shocks/ATP Therapy. This joins a growing body of literature on the long-term effects of Milrinone as it is utilized in end-stage heart failure. Milrinone is a commonly used inotrope due to favorable hemodynamic effects in patients with advanced HF. The effect of Milrinone on ventricular arrhythmias has not been completely defined. The aim of this study was to assess the effect of IV chronic Milrinone therapy on the burden of ventricular arrhythmias. In this single-center, retrospective analysis, data from 75 consecutive patients who underwent Milrinone therapy for symptomatic advanced heart failure from 11/2017 to 9/2019 were reviewed. Those with complete follow up and device interrogation prior and after Milrinone initiation were included in the study. CRM remote monitoring data was used to obtain the burden of ventricular arrhythmias and baseline clinical parameters including medications and echocardiographic data were retrospectively abstracted from EMRs. A total of 28 patients were included in the study (Average Age=67±17 years, 89% Male, Baseline LVEF=22±7%, ICM 43%). Using remote monitoring data, the daily average burden of sustained VT/VF, NSVT, ICD shocks/ATP therapy and total ventricular arrhythmias in the 6-month period prior to Milrinone initiation were 0.004±0.002, 0.05±0.02, 0.0004±0.0003 and 0.05±0.02 episodes, respectively. Patient received Milrinone therapy (Mean Dose=0.44±0.02 mcg/kg/min) and during the follow-up period while receiving Milrinone (Mean follow-up 214±26 days), the daily average burden of sustained VT/VF, NSVT, ICD shocks/ATP therapy and total ventricular arrhythmias more than doubled and were 0.009±0.008, 0.12±0.05, 0.001±0.0006 and 0.13±0.06 episodes, respectively. From univariate regression analysis, only the average dose of Milrinone was associated with increased burden of ventricular arrhythmias (R2=0.16, P=0.034). This study demonstrated an increase in the total burden of NSVT and Sustained VT and VF as well as Total Burden of ICD Shocks/ATP Therapy. This joins a growing body of literature on the long-term effects of Milrinone as it is utilized in end-stage heart failure.