The Role of Ventricular Tachycardia in LVAD Patients and Clinical Outcomes

Abstract

Introduction Ventricular tachycardia (VT) is common in patients with end-stage heart failure, and pose additional risks in patients who have left ventricular assist devices (LVAD). We set out to examine if development of VT increases risk of mortality post-LVAD and the odds of developing right ventricular failure (RVF). Hypothesis New onset VT increases both the risk of 1-year mortality post-LVAD and the odds of developing RVF. Methods We performed a single-center retrospective analysis of 295 patients who received a continuous-flow durable LVAD (HeartMate II or HeartWare VAD) between Jan. 1st 2006 through Dec. 31st 2016. We stratified patients to 2 cohorts: those who had positive or negative history of VT pre-LVAD and those who developed VT post-LVAD. A survival analysis based on 1-year survival was performed to find predictors of mortality and association with RVF. RVF severity was defined according to the new INTERMACS criteria. Results In patients with and without a history of VT, 113 (67%) and 74 (58%) respectively developed VT post-LVAD. Baseline characteristics were similar among all cohorts (Table 1). Survival analysis demonstrated that both new onset VT (Figure 1) and recurrence of VT did not increase the risk of 1 year mortality post-LVAD. Additionally, univariable analysis in patients without history of VT pre-LVAD showed that VT increased the odds of developing severe RVF (Table 2) (OR 6.20, p=0.020, 95%CI [1.33 - 29.0]), but this was no longer significant in multivariable analysis. Conclusions New onset and recurrent VT do not appear to be associated with increased mortality in LVAD patients. While there is a signal that new onset VT may increase the odds of severe RVF in patients without VT history pre-LVAD, this needs to be addressed prospectively and in larger cohorts.