Early Ventricular Arrhythmias After Left Ventricular Assist Device Implantation

• Published in: Journal of cardiac failure Vol. 30; no. 8; pp. 1018 - 1027
• Main Authors: Oates, Connor P., Lam, Phillip H., Lawrence, Luke, Bigham, Grace, Meda, Namratha S., Basyal, Binaya, Hadadi, Cyrus A., Rao, Sriram D., Hockstein, Michael, Shah, Manish, Sheikh, Farooq H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2024
• Subjects: left ventricular assist device; ventricular fibrillation; Ventricular tachycardia; ventricular fibrillation; Ventricular tachycardia; left ventricular assist device
• ISSN: 1071-9164; 1532-8414; 1532-8414
• DOI: 10.1016/j.cardfail.2023.11.018

•Early ventricular arrhythmias (EVAs) occur frequently after LVAD implantation and are associated with increased 30-day mortality.•A history of ESRD, preoperative electrical storm, and appropriate ICD therapy before implantation are risk factors associated with the development of EVAs.•Strategies to mitigate EVAs after LVAD implantation are an important consideration before LVAD implantation. Although sustained ventricular arrhythmias (VAs) are a common complication after durable left ventricular assist device (LVAD) implantation, the incidence, risk factors, and prognostic implications of postoperative early VAs (EVAs) in contemporary patients with LVAD are poorly understood. A single-center retrospective analysis was performed of patients who underwent LVAD implantation from October 1, 2006, to October 1, 2022. EVA was defined as an episode of sustained VA identified ≤30 days after LVAD implantation. A total of 789 patients underwent LVAD implantation (mean age 62.9 ± 0. years 5, HeartMate 3 41.4%, destination therapy 43.3%). EVAs occurred in 100 patients (12.7%). A history of end-stage renal disease (odds ratio [OR] 5.6, 95% confidence interval [CI] 1.45–21.70), preoperative electrical storm (OR 2.82, 95% CI 1.11–7.16), and appropriate implantable cardiac defibrillator therapy before implantation (OR 2.8, 95% CI 1.26–6.19) are independently associated with EVAs. EVA was associated with decreased 30-day survival (hazard ratio 3.02, 95% CI 1.1–8.3, P = .032). There was no difference in transplant-free survival time between patients with and without EVAs (hazard ratio 0.82, 95% CI 0.5–1.4, P = .454). EVAs are common after durable LVAD implantation and are associated with an increased risk of 30-day mortality.