Author + information
- Received August 16, 2017
- Revision received October 10, 2017
- Accepted November 2, 2017
- Published online February 19, 2018.
- Brian D. Greet, MDa,
- Deep Pujara, MDa,
- David Burkland, MDa,
- Mark Pollet, MDa,
- Deepthi Sudhakar, MDa,
- Francia Rojas, MDb,
- Briana Costello, MDa,
- Alexander Postalian, MDa,
- Zachary Hale, MDa,
- Ben Jenny, MDa,
- Carol Lai, MDa,
- Kenneth Igbalode, MDa,
- Divesh Wadhera, MDa,
- Ajith Nair, MDa,
- Masahiro Ono, MDc,
- Jeffrey Morgan, MDc,
- Leo Simpson, MDa,
- Andrew Civitello, MDa,
- Jie Cheng, MD, PhDb and
- Nilesh Mathuria, MDb,∗ ()
- aDivision of Cardiology, Baylor College of Medicine, Houston, Texas
- bTexas Heart Institute, Texas Medical Center, Houston, Texas
- cDivision of Cardiovascular Surgery, Baylor College of Medicine, Houston, Texas
- ↵∗Address for correspondence:
Dr. Nilesh Mathuria, Texas Heart Institute, Baylor College of Medicine, PO Box 20345, MC 2-225, Houston, Texas 77225-0345.
Objectives The aim of this study was to evaluate the incidence, predictors, and associated mortality of pre-implantation, early, and late ventricular arrhythmias (VAs) in patients receiving continuous-flow left ventricular assist devices (CFLVADs).
Background VAs are common both pre- and post-implantation of left ventricular assist devices. Limited data exist on their prognostic impact in contemporary CFLVADs.
Methods A retrospective review was performed to identify patients who underwent CFLVAD implantation between 2000 and 2015 with 2 years of follow-up. All VAs, defined as ventricular fibrillation, ventricular tachycardia lasting >30 s, or a ventricular rhythm requiring defibrillation, were analyzed. VAs occurring within 30 days of implantation were defined as early. Recorded outcomes included death and receipt of cardiac transplant.
Results A total of 517 patients were included for analysis. Early VAs were associated with a significant reduction in survival (hazard ratio: 1.83; 95% confidence interval: 1.28 to 2.61; p = 0.001) compared with patients with late or no VAs. Pre-implantation variables independently predictive of early VAs included prior cardiac surgery (odds ratio: 1.90; 95% confidence interval: 1.09 to 3.32; p = 0.023) and pre-CFLVAD ventricular tachycardia storm (odds ratio: 3.15; 95% confidence interval: 1.49 to 6.69; p = 0.003). The incidence of early VAs from 2000 to 2007 was as high as 47%, whereas the highest incidence from 2008 to 2015 was <22%.
Conclusions VAs within 30 days after CFLVAD implantation are associated with an increased risk for death. Predictors of early VAs include prior cardiac surgery and pre-CFLVAD ventricular tachycardia storm. Temporal trends have shown a decrease in VA from 2000 to 2015. Strategies to reduce arrhythmia burden shortly after CFLVAD implantation warrant further investigation.
- cardiac arrhythmia
- continuous-flow left ventricular assist device
- left ventricular assist device
- ventricular arrhythmia
- ventricular fibrillation
- ventricular tachycardia
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Greet and Pujara contributed equally to this work.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received August 16, 2017.
- Revision received October 10, 2017.
- Accepted November 2, 2017.
- 2018 American College of Cardiology Foundation
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