Author + information
- Received February 5, 2018
- Revision received April 26, 2018
- Accepted May 17, 2018
- Published online September 17, 2018.
- Vincent Galand, MDa,b,c,
- Erwan Flécher, MD, PhDb,d,
- Vincent Auffret, MDa,b,c,
- Stéphane Boulé, MDe,
- André Vincentelli, MD, PhDe,
- Camille Dambrin, MD, PhDf,
- Pierre Mondoly, MDf,
- Frédéric Sacher, MD, PhDg,
- Karine Nubret, MDg,
- Michel Kindo, MD, PhDh,
- Thomas Cardi, MDh,
- Philippe Gaudard, MDi,
- Philippe Rouvière, MDi,
- Magali Michel, MDj,
- Jean-Baptiste Gourraud, MDj,
- Pascal Defaye, MDk,
- Olivier Chavanon, MD, PhDk,
- Constance Verdonk, MDl,
- Walid Ghodbane, MDl,
- Edeline Pelcé, MDm,
- Vlad Gariboldi, MD, PhDm,
- Matteo Pozzi, MDn,
- Jean-François Obadia, MD, PhDn,
- Pierre-Yves Litzler, MD, PhDo,
- Frédéric Anselme, MDo,
- Gerard Babatasi, MD, PhDp,
- Annette Belin, MDp,
- Fabien Garnier, MDq,
- Marie Bielefeld, MDq,
- David Hamon, MDr,
- Costin Radu, MDr,
- Bertrand Pierre, MDs,
- Thierry Bourguignon, MDs,
- Romain Eschalier, MD, PhDt,
- Nicolas D’Ostrevy, MDt,
- Marie-Cécile Bories, MDu,
- Eloi Marijon, MD, PhDu,
- Fabrice Vanhuyse, MDv,
- Hugues Blangy, MDv,
- Jean-Philippe Verhoye, MD, PhDd,
- Christophe Leclercq, MD, PhDa,b,c,
- Raphaël P. Martins, MD, PhDa,b,c,∗ (, )
- on behalf of the ASSIST-ICD Investigators
- aService de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France
- bUniversité de Rennes 1, Rennes, France
- cU1099, INSERM, Rennes, France
- dService de chirurgie cardiaque et thoracique, Rennes, France
- eDepartment of Cardiac Surgery, Department of Cardiology, Cardiac Intensive Care Unit, Institut Coeur-Poumons, CHU Lille, Lille, France
- fService de Cardiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- gService de Cardiologie, Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
- hDépartement de chirurgie cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- iDepartment of Cardiac Surgery, Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France
- jDepartment of Cardiology and Heart Transplantation Unit, CHU Nantes, Nantes, France
- kDepartment of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
- lDepartment of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France
- mDepartment of Cardiac Surgery, La Timone Hospital, Marseille, France
- nDepartment of Cardiac Surgery, “Louis Pradel” Cardiologic Hospital, Lyon, France
- oDepartment of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
- pDepartment of Cardiology and Cardiac Surgery, University Hospital of Caen, University of Caen, Caen, France
- qDepartment of Cardiology and Cardiac Surgery, University Hospital Dijon Bourgogne, Dijon, France
- rDepartment of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France
- sDepartment of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France
- tCardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
- uCardiology Department, European Georges Pompidou Hospital, Paris, France
- vDepartment of Cardiology and Cardiac Surgery, Hopital de Brabois, CHU de Nancy, Nancy, France
- ↵∗Address for correspondence:
Dr. Raphaël P. Martins, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France.
Objectives This study aimed to evaluate the incidence, clinical impact, and predictors of late ventricular arrhythmias (VAs) in left ventricular assist device (LVAD) recipients aiming to clarify implantable cardioverter-defibrillator (ICD) indications.
Background The arrhythmic risk and need for ICD in patients implanted with an LVAD are not very well known.
Methods This observational study was conducted in 19 centers between 2006 and 2016. Late VAs were defined as sustained ventricular tachycardia or fibrillation occurring >30 days post-LVAD implantation, without acute reversible cause and requiring appropriate ICD therapy, external electrical shock, or medical therapy.
Results Among 659 LVAD recipients, 494 (median 58.9 years of age; mean left ventricular ejection fraction 20.7 ± 7.4%; 73.1% HeartMate II, 18.6% HeartWare, 8.3% Jarvik 2000) were discharged alive from hospital and included in the final analysis. Late VAs occurred in 133 (26.9%) patients. Multivariable analysis identified 6 independent predictors of late VAs: VAs before LVAD implantation, atrial fibrillation before LVAD implantation, idiopathic etiology of the cardiomyopathy, heart failure duration >12 months, early VAs (<30 days post-LVAD), and no angiotensin-converting enzyme inhibitors during follow-up. The “VT-LVAD score” was created, identifying 4 risk groups: low (score 0 to 1), intermediate (score 2 to 4), high (score 5 to 6), and very high (score 7 to 10). The rates of VAs at 1 year were 0.0%, 8.0%, 31.0% and 55.0%, respectively.
Conclusions Late VAs are common after LVAD implantation. The VT-LVAD score may help to identify patients at risk of late VAs and guide ICD indications in previously nonimplanted patients. (Determination of Risk Factors of Ventricular Arrhythmias [VAs] after implantation of continuous flow left ventricular assist device with continuous flow left ventricular assist device [CF-LVAD] [ASSIST-ICD]; NCT02873169)
This research was supported in part by French Federation of Cardiology. Drs. Mondoly has received consulting honoraria from Biotronik, Boston Scientific, Medtronic, Abbott, and LivaNova. Dr. Sacher has received speaker honoraria from Abbott, Medtronic, Boston Scientific, Biosense Webster, and Livanova. Dr. Kindo has received honorarium from HeartWare. Dr. Defay has received honoraria from Boston Scientific, Medtronic, Abbott, and LivaNova. Dr. Chavanon has received an honorarium from Thoratec. Dr. Anselme has received honoraria from Medtronic, LivaNova, Boston Scientific, and Abbott. Dr. Obadia has received honorarium from Abbott. Dr Garnier has received honoraria from Boston Scientific and Medtronic. Dr. Blangy has received honoraria from Boston Scientific, Medtronic, Abbott, and LivaNova. Dr. Leclercq has served as a speaker for Biotronik, BSI, Medtronic, Abbott, and LivaNova. Dr. Martins has received honoraria from Medtronic, Abbott, and LivaNova. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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 February 5, 2018.
- Revision received April 26, 2018.
- Accepted May 17, 2018.
- 2018 American College of Cardiology Foundation
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