Early Ventricular Arrhythmias After LVAD Implantation Is the Strongest Predictor of 30-Day Post-Operative Mortality

Vincent Galand; Erwan Flécher; Vincent Auffret; Camille Pichard; Stéphane Boulé; André Vincentelli; Anne Rollin; Pierre Mondoly; Laurent Barandon; Mathieu Pernot; Michel Kindo; Thomas Cardi; Philippe Gaudard; Philippe Rouvière; Thomas Sénage; Nicolas Jacob; Pascal Defaye; Olivier Chavanon; Constance Verdonk; Walid Ghodbane; Edeline Pelcé; Vlad Gariboldi; Matteo Pozzi; Jean-François Obadia; Arnaud Savouré; Frédéric Anselme; Gerard Babatasi; Annette Belin; Fabien Garnier; Marie Bielefeld; David Hamon; Nicolas Lellouche; Bertrand Pierre; Thierry Bourguignon; Romain Eschalier; Nicolas D’Ostrevy; Marie-Cécile Bories; Eloi Marijon; Fabrice Vanhuyse; Hugues Blangy; Jean-Philippe Verhoye; Christophe Leclercq; Raphaël P. Martins

doi:10.1016/j.jacep.2019.05.025

JACC: Clinical Electrophysiology

Volume 5, Issue 8, August 2019 DOI: 10.1016/j.jacep.2019.05.025

Early Ventricular Arrhythmias After LVAD Implantation Is the Strongest Predictor of 30-Day Post-Operative Mortality

Vincent Galand, Erwan Flécher, Vincent Auffret, Camille Pichard, Stéphane Boulé, André Vincentelli, Anne Rollin, Pierre Mondoly, Laurent Barandon, Mathieu Pernot, Michel Kindo, Thomas Cardi, Philippe Gaudard, Philippe Rouvière, Thomas Sénage, Nicolas Jacob, Pascal Defaye, Olivier Chavanon, Constance Verdonk, Walid Ghodbane, Edeline Pelcé, Vlad Gariboldi, Matteo Pozzi, Jean-François Obadia, Arnaud Savouré, Frédéric Anselme, Gerard Babatasi, Annette Belin, Fabien Garnier, Marie Bielefeld, David Hamon, Nicolas Lellouche, Bertrand Pierre, Thierry Bourguignon, Romain Eschalier, Nicolas D’Ostrevy, Marie-Cécile Bories, Eloi Marijon, Fabrice Vanhuyse, Hugues Blangy, Jean-Philippe Verhoye, Christophe Leclercq and Raphaël P. Martins

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Author + information

vol. 5 no. 8 944-954

DOI:

https://doi.org/10.1016/j.jacep.2019.05.025

Published By:

JACC: Clinical Electrophysiology

Print ISSN:

2405-5018

Online ISSN:

2405-500X

History:

Received January 11, 2019
Revision received May 22, 2019
Accepted May 30, 2019
Published online August 19, 2019.

2019 American College of Cardiology Foundation

Author Information

Vincent Galand, MD^a,
Erwan Flécher, MD, PhD^a,
Vincent Auffret, MD^a,
Camille Pichard, MD^a,
Stéphane Boulé, MD^b,
André Vincentelli, MD, PhD^b,
Anne Rollin, MD^c,
Pierre Mondoly, MD^c,
Laurent Barandon, MD, PhD^d,
Mathieu Pernot, MD^d,
Michel Kindo, MD, PhD^e,
Thomas Cardi, MD^e,
Philippe Gaudard, MD^f,
Philippe Rouvière, MD^f,
Thomas Sénage, MD^g,
Nicolas Jacob, MD^g,
Pascal Defaye, MD^h,
Olivier Chavanon, MD, PhD^h,
Constance Verdonk, MDⁱ,
Walid Ghodbane, MDⁱ,
Edeline Pelcé, MD^j,
Vlad Gariboldi, MD, PhD^j,
Matteo Pozzi, MD^k,
Jean-François Obadia, MD, PhD^k,
Arnaud Savouré, MD^l,
Frédéric Anselme, MD^l,
Gerard Babatasi, MD, PhD^m,
Annette Belin, MD^m,
Fabien Garnier, MDⁿ,
Marie Bielefeld, MDⁿ,
David Hamon, MD^o,
Nicolas Lellouche, MD, PhD^o,
Bertrand Pierre, MD^p,
Thierry Bourguignon, MD^p,
Romain Eschalier, MD, PhD^q,
Nicolas D’Ostrevy, MD^q,
Marie-Cécile Bories, MD^r,
Eloi Marijon, MD, PhD^r,
Fabrice Vanhuyse, MD^s,
Hugues Blangy, MD^s,
Jean-Philippe Verhoye, MD, PhD^a,
Christophe Leclercq, MD, PhD^a and
Raphaël P. Martins, MD, PhD^a,^∗ (raphael.martins{at}chu-rennes.fr)

^aUniv Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
^bDepartment of Cardiology and Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, Lille, France
^cDepartment of Cardiology, Department of Cardiac Surgery, CHU de Toulouse, Toulouse, France
^dHôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
^eDepartment of Cardiovascular Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
^fDepartment of Anesthesiology and Critical Care Medicine, PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Cardiac Surgery, University of Montpellier, CHU Montpellier, Montpellier, France
^gDepartment of Cardiology and Heart Transplantation Unit, CHU Nantes, France
^hDepartment of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
ⁱDepartment of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France
^jDepartment of Cardiac Surgery, La Timone Hospital, Marseille, France
^kDepartment of Cardiac Surgery, “Louis Pradel” Cardiologic Hospital, Lyon, France
^lDepartment of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
^mDepartment of Cardiology and Cardiac Surgery, University Hospital of Caen, University of Caen, Caen, France
ⁿDepartment of Cardiology and Cardiac Surgery, University Hospital, Dijon, France
^oDepartment of Cardiology and Cardiac Surgery, Assistance Publique–Hôpitaux de Paris, CHU Henri Mondor, Créteil, France
^pDepartment of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France
^qCardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
^rCardiology Department, European Georges Pompidou Hospital, Paris, France
^sDepartment of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France

↵∗Address for correspondence:
Dr. Raphael P. Martins, Service de Cardiologie et Maladies Vasculaires, Centre Hospitalier Universitaire de Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France.

Central Illustration

Abstract

Objectives This study aimed to evaluate incidence, clinical significance, and predictors of early ventricular arrhythmias (VAs) in left ventricular assist device (LVAD) recipients.

Background LVAD implantation is increasingly used in patients with end-stage heart failure. Early VAs may occur during the 30-day post-operative period, but many questions remain unanswered regarding their incidence and clinical impact.

Methods This observational study was conducted in 19 centers between 2006 and 2016. Early VAs were defined as sustained ventricular tachycardia and/or ventricular fibrillation occurring <30 days post-LVAD implantation and requiring appropriate implantable cardioverter-defibrillator therapy, external electrical shock, or medical therapy.

Results A total of 652 patients (median age: 59.8 years; left ventricular ejection fraction: 20.7 ± 7.4%; HeartMate 2: 72.8%; HeartWare: 19.5%; Jarvik 2000: 7.7%) were included in the analysis. Early VAs occurred in 162 patients (24.8%), most frequently during the first week after LVAD implantation. Multivariable analysis identified history of VAs prior to LVAD and any combined surgery with LVAD as 2 predictors of early VAs. The occurrence of early VAs with electrical storm was the strongest predictor of 30-day post-operative mortality, associated with a 7-fold increase of 30-day mortality. However, in patients discharged alive from hospital, occurrence of early VAs did not influence long-term survival.

Conclusions Early VAs are common after LVAD implantation and increase 30-day post-operative mortality, without affecting long-term survival. Further studies will be needed to analyze whether pre- or pre-operative ablation of VAs may improve post-operative outcomes. (Determination of Risk Factors of Ventricular Arrhythmias After Implantation of Continuous Flow Left Ventricular Assist Device With Continuous Flow Left Ventricular Assist Device [ASSIST-ICD]; NCT02873169)

Key Words

Footnotes

This research was supported in part by French Federation of Cardiology. Dr. Mondoly has received honoraria from Biotronik, Boston Scientific, Medtronic, Abbott, and LivaNova. Dr. Kindo has received honorarium from HeartWare. Dr. Defay has received honoraria from Boston Scientific, Medtronic, Abbott, LivaNova, and Microport. Dr. Chavanon has received honorarium from Thoratec. Dr. Obadia has received consulting honorarium from Abbott, Medtronic, Landanger, Delacrois-Chevalier, and Sanofi. Dr. Anselme has received honoraria from Medtronic, LivaNova, Boston Scientific, and Abbott. Dr. Garnier has received honoraria from Boston Scientific and Medtronic. Dr. Blangy has received consulting honoraria from Boston Scientific, Medtronic, Abbott, Biotronik, Microport, and LivaNova. Dr. Leclercq has received consulting honoraria from Biotronik, Boston Scientific, 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.
The 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 January 11, 2019.
Revision received May 22, 2019.
Accepted May 30, 2019.

2019 American College of Cardiology Foundation

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