Author + information
- Received May 31, 2018
- Revision received November 28, 2018
- Accepted November 28, 2018
- Published online January 30, 2019.
- Andrew E. Noll, MDa,
- Joseph Adewumi, MDb,
- Ram Amuthan, MDb,
- Carl B. Gillombardo, MDb,
- Zariyat Mannan, MDb,
- Erich L. Kiehl, MDc,
- Ayman A. Hussein, MDc,
- Mina K. Chung, MDc,
- Oussama M. Wazni, MDc,
- Randall C. Starling, MD, MPHd,
- Edward G. Soltesz, MD, MPHe and
- Daniel J. Cantillon, MDc,∗ ()
- aDepartment of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
- bDepartment of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
- cDepartment of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic Foundation, Cleveland, Ohio
- dDepartment of Cardiovascular Medicine, Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio
- eDepartment of Cardiothoracic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Daniel J. Cantillon, Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic Foundation, 9500 Euclid Avenue, J2-2, Cleveland, Ohio 44195.
Objectives This study sought to describe the burden of atrial fibrillation (AF)/atrial flutter (AFL) in patients with left ventricular assist devices (LVAD) and to evaluate the impact of rhythm control strategies.
Background AF and AFL among patients with LVADs are poorly characterized.
Methods Retrospective multivariable survival analysis of all LVAD recipients at the Cleveland Clinic from January 1, 2004 to June 30, 2016 examining the association of death, thromboembolism, and major bleeding with AF/AFL and exposure to rhythm control measures.
Results Among 418 patients (median age: 58; [interquartile range: 50 to 67] years, 80% male) with median follow-up of 445 (interquartile range: 165 to 936) days, AF (n = 287 of 418, 69%) and AFL (n = 61 of 418, 15%) were highly prevalent. Patients with AF/AFL (n = 302 of 418, 72%) and without AF/AFL (n = 116 of 418, 28%) had similar mortality (39% vs. 38%; p = 0.88) and major bleeding (46% vs. 49%; p = 0.53); AF/AFL patients had fewer thromboembolic events (13% vs. 23%; p < 0.01). Paroxysmal or persistent AF/AFL was present in 238 patients (57%), and rhythm control exposure (n = 166, 70%) was not associated with decreased mortality (39% vs. 43%; p = 0.57), thromboembolism (13% vs. 17%; p = 0.41), or bleeding (49% vs. 39%; p = 0.16). In the multivariable survival analysis only prior valve surgery (hazard ratio: 2.0; 95% confidence interval: 1.3 to 3.0; p = 0.002) was associated with increased hazard; AF/AFL had no association with risk of death, thromboembolism, or bleeding.
Conclusions Though highly prevalent among LVAD patients, AF/AFL was not associated with increased mortality, thromboembolism, or bleeding, and among paroxysmal/persistent AF patients, rhythm control measures were not associated with improved outcomes.
- atrial arrhythmias
- atrial fibrillation
- atrial flutter
- left ventricular assist devices
- mechanical circulatory support
- survival analysis
Dr. Starling is on the advisory panel (without honoraria) for Medtronic. Dr. Cantillon has received consulting fees from Abbott, Biosense, and Boston Scientific. 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 May 31, 2018.
- Revision received November 28, 2018.
- Accepted November 28, 2018.
- 2019 American College of Cardiology Foundation
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