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Predictors and Clinical Impact of Late Ventricular Arrhythmias in Patients With Continuous-Flow Left Ventricular Assist Devices

2018; Elsevier BV; Volume: 4; Issue: 9 Linguagem: Inglês

10.1016/j.jacep.2018.05.006

2405-5018

Vincent Galand, Erwan Flécher, Vincent Auffret, Stéphane Boulé, André Vincentelli, Camille Dambrin, Pierre Mondoly, Frédéric Sacher, Karine Nubret, Michel Kindo, Thomas Cardi, Philippe Gaudard, Philippe Rouvière, Magali Michel, Jean‐Baptiste Gourraud, Pascal Defaye, Olivier Chavanon, Constance Verdonk, Walid Ghodbane, Edeline Pelcé, Vlad Gariboldi, Mattéo Pozzi, Jean‐François Obadia, Pierre-Yves Litzler, Frédéric Anselme, Gérard Babatasi, Annette Belin, Fabien Garnier, Marie Bielefeld, David Hamon, Costin Radu, Bertrand Pierre, Thierry Bourguignon, Romain Eschalier, Nicolas D’Ostrevy, Marie-Cécile Bories, Éloi Marijon, Fabrice Vanhuyse, Hugues Blangy, Jean‐Philippe Verhoye, Christophe Leclercq, Raphaël P. Martins,

Cardiac pacing and defibrillation studies

This study aimed to evaluate the incidence, clinical impact, and predictors of late ventricular arrhythmias (VAs) in left ventricular assist device (LVAD) recipients aiming to clarify implantable cardioverter-defibrillator (ICD) indications. The arrhythmic risk and need for ICD in patients implanted with an LVAD are not very well known. This observational study was conducted in 19 centers between 2006 and 2016. Late VAs were defined as sustained ventricular tachycardia or fibrillation occurring >30 days post-LVAD implantation, without acute reversible cause and requiring appropriate ICD therapy, external electrical shock, or medical therapy. Among 659 LVAD recipients, 494 (median 58.9 years of age; mean left ventricular ejection fraction 20.7 ± 7.4%; 73.1% HeartMate II, 18.6% HeartWare, 8.3% Jarvik 2000) were discharged alive from hospital and included in the final analysis. Late VAs occurred in 133 (26.9%) patients. Multivariable analysis identified 6 independent predictors of late VAs: VAs before LVAD implantation, atrial fibrillation before LVAD implantation, idiopathic etiology of the cardiomyopathy, heart failure duration >12 months, early VAs (<30 days post-LVAD), and no angiotensin-converting enzyme inhibitors during follow-up. The “VT-LVAD score” was created, identifying 4 risk groups: low (score 0 to 1), intermediate (score 2 to 4), high (score 5 to 6), and very high (score 7 to 10). The rates of VAs at 1 year were 0.0%, 8.0%, 31.0% and 55.0%, respectively. Late VAs are common after LVAD implantation. The VT-LVAD score may help to identify patients at risk of late VAs and guide ICD indications in previously nonimplanted patients. (Determination of Risk Factors of Ventricular Arrhythmias [VAs] after implantation of continuous flow left ventricular assist device with continuous flow left ventricular assist device [CF-LVAD] [ASSIST-ICD]; NCT02873169)