Incidence, Predictors, and Significance of?Ventricular Arrhythmias in Patients With?Continuous-Flow Left Ventricular Assist Devices

摘要

ObjectivesThe aim of this study was to evaluate the incidence, predictors, and associated mortality of pre-implantation, early, and late ventricular arrhythmias (VAs) in patients receiving continuous-flow left ventricular assist?devices (CFLVADs). BackgroundVAs are common both pre- and post-implantation of left ventricular assist devices. Limited data exist?on their prognostic impact in contemporary CFLVADs. MethodsA retrospective review was performed to identify patients who underwent CFLVAD implantation between?2000 and 2015 with 2 years of follow-up. All VAs, defined as ventricular fibrillation, ventricular tachycardia lasting >30 s, or a ventricular rhythm requiring defibrillation, were analyzed. VAs occurring within 30 days of implantation were defined as early. Recorded outcomes included death and receipt of cardiac transplant. ResultsA total of 517 patients were included for analysis. Early VAs were associated with a significant reduction in?survival (hazard ratio: 1.83; 95% confidence interval: 1.28 to 2.61; p?= 0.001) compared with patients with late?or?no?VAs. Pre-implantation variables independently predictive of early VAs included prior cardiac surgery (odds?ratio: 1.90; 95% confidence interval: 1.09 to 3.32; p?= 0.023) and pre-CFLVAD ventricular tachycardia storm (odds?ratio: 3.15; 95% confidence interval: 1.49 to 6.69; p?= 0.003). The incidence of early VAs from 2000 to 2007 was as high as 47%, whereas the highest incidence from 2008 to 2015 was?<22%. ConclusionsVAs within 30 days after CFLVAD implantation are associated with an increased risk for death. Predictors of early VAs include prior cardiac surgery and pre-CFLVAD ventricular tachycardia storm. Temporal trends have?shown a decrease in VA from 2000 to 2015. Strategies to reduce arrhythmia burden shortly after CFLVAD?implantation?warrant further investigation.