The Clinical Impact of Ventricular Arrhythmias Following Continuous Flow Left Ventricular Assist Device Implantation

• Published in: The Journal of heart and lung transplantation Vol. 32; no. 4; p. S173
• Main Authors: Garan, A.R, Morrison, K, Letarte, L, Vazquez, J, Dano, D, Colombo, P, Yuzefpolskaya, M, Te-Frey, R, Takayama, H, Naka, Y, Morrow, J, Garan, H, Jorde, U.P, Uriel, N
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2013
• Subjects: Surgery
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2013.01.413

Purpose Ventricular arrhythmias (VA) are common in patients with a continuous flow left-ventricular assist device (CF-LVAD) but prospective data to support the routine ICD use in these patients are lacking. The aim of this study was to evaluate the prevalence and significance of Vas as well as the role of ICDs in this population. Methods and Materials All patients with a long-term CF-LVAD receiving care at our institution were enrolled. ICDs were interrogated at baseline and throughout prospective follow-up. VA was defined as VT/VF lasting > 30 seconds or effectively terminated by appropriate ICD therapy. The primary outcome was the occurrence of late Vas (more than 30 days after CF-LVAD implant); secondary outcomes were early Vas (within 30 days post-operatively) and all-cause mortality. Results Ninety-four patients were enrolled; seventy-seven had an ICD and 17 did not. Five patients with an ICD had it de-activated or a depleted battery not replaced during the study. Patients without an ICD were more likely to be women (58.8% vs. 90.9%, p=0.003), have shorter disease duration (35.3% vs. 97.4%, p<0.001), and smaller left ventricular end-diastolic dimensions (5.8 + 1.0cm vs. 7.0 + 0.9cm, p<0.001). Twenty-two patients (23.4%) had a late VA. Nineteen had an early VA; of these, 9 (47.4%) also had late Vas. Early Vas did not result in more hospital or ICU days during the index admission. Pre-operative VA was the lone independent predictor of late VA; a lack of pre-operative VA conferred a low risk of late VA (4.0% vs. 45.5%; p< 0.001). Six patients (6.4%) had a prolonged VA episode and all presented with right ventricular failure. There was no difference in survival between those with and without active ICD (90.5% vs. 85.6%; p=0.55). Conclusions CF-LVAD patients with pre-operative Vas are at risk of recurrent Vas. Active ICD may minimize the morbidities associated with sustained Vas. Patients without pre-operative Vas are at low risk of post-operative Vas and may not need ICD therapy.