Incidence, Predictors, and Outcomes With Ventricular Arrhythmias in Continuous Flow Left Ventricular Assist Device Recipients: A Multicenter Analysis.

BACKGROUND

Ventricular arrhythmias (VAs) are common in patients with left ventricular assist devices (LVADs), but their prognostic impact remains uncertain. Prior studies have yielded conflicting results regarding their association with mortality and morbidity. We aimed to evaluate the incidence and clinical outcomes associated with VAs in a large, multicenter LVAD cohort.

METHODS

We analyzed 408 patients who underwent LVAD implantation across five centers between 2007 and 2015. VA was defined as sustained VAs lasting > 30 s or requiring ICD therapy. The effects of pre- and post-LVAD VA on clinical outcomes-including survival, hospitalizations, and ICD shocks-were assessed.

RESULTS

Of 408 patients, 254 (62%) had a history of pre-LVAD VA. Compared to those without prior VA, patients with pre-LVAD VA were more likely to be male (85% vs. 75%, p = 0.02), receive amiodarone (44% vs. 31%, p = 0.01), and have larger left ventricular end-diastolic dimension (LVEDD) (7.1 vs. 6.8 cm, p = 0.01). Postimplant, the pre-VA group had a significantly higher incidence of VA (73% vs. 37%, p < 0.0001), atrial arrhythmias (63% vs. 42%, p < 0.0001), ICD shocks (41% vs. 32%, p = 0.001), and cardiac hospitalizations (median 0.20 vs. 0.08 events/year, p = 0.0003). However, Kaplan-Meier survival analysis showed no significant difference in overall mortality (log-rank p = 0.10). On multivariate Cox regression, pre-LVAD VA predicted post-LVAD VA, but LVEDD was the only independent predictor of mortality.

CONCLUSIONS

In this multicenter cohort, pre-LVAD VAs were strongly associated with postimplant arrhythmic burden and increased morbidity, but not with long-term mortality. These findings highlight the importance of structural factors such as LVEDD over arrhythmia history in survival outcomes and underscore the need for individualized arrhythmia surveillance and management strategies in LVAD recipients with prior VAs.