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JACC Clin Electrophysiol. 2019 Aug;5(8):944-954. doi: 10.1016/j.jacep.2019.05.025. Epub 2019 Aug 19.

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

Author information

1
Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France.
2
Department of Cardiology and Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, Lille, France.
3
Department of Cardiology, Department of Cardiac Surgery, CHU de Toulouse, Toulouse, France.
4
Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France.
5
Department of Cardiovascular Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
6
Department of Anesthesiology and Critical Care Medicine, PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Cardiac Surgery, University of Montpellier, CHU Montpellier, Montpellier, France.
7
Department of Cardiology and Heart Transplantation Unit, CHU Nantes, France.
8
Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France.
9
Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France.
10
Department of Cardiac Surgery, La Timone Hospital, Marseille, France.
11
Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France.
12
Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France.
13
Department of Cardiology and Cardiac Surgery, University Hospital of Caen, University of Caen, Caen, France.
14
Department of Cardiology and Cardiac Surgery, University Hospital, Dijon, France.
15
Department of Cardiology and Cardiac Surgery, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Créteil, France.
16
Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France.
17
Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.
18
Cardiology Department, European Georges Pompidou Hospital, Paris, France.
19
Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France.
20
Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France. Electronic address: raphael.martins@chu-rennes.fr.

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).

KEYWORDS:

left ventricular assist device; post-operative mortality; ventricular arrhythmia

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