Predictors and Clinical Impact of Late Ventricular Arrhythmias in Patients With Continuous-Flow Left Ventricular Assist Devices.
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Galand Vincent, Flécher Erwan, Auffret Vincent, Boulé Stéphane, Vincentelli André, Dambrin Camille, Mondoly Pierre, Sacher Frédéric, Nubret Karine, Kindo Michel, Cardi Thomas, Gaudard Philippe, Rouvière Philippe, Michel Magali, Gourraud Jean-Baptiste, Defaye Pascal, Chavanon Olivier, Verdonk Constance, Ghodbane Walid, Pelcé Edeline, Gariboldi Vlad, Pozzi Matteo, Obadia Jean-François, Litzler Pierre-Yves, Anselme Frédéric, Babatasi Gerard, Belin Annette, Garnier Fabien, Bielefeld Marie, Hamon David, Radu Costin, Pierre Bertrand, Bourguignon Thierry, Eschalier Romain, D'Ostrevy Nicolas, Bories Marie-Cécile, Marijon Eloi, Vanhuyse Fabrice, Blangy Hugues, Verhoye Jean-Philippe, Leclercq Christophe, Martins Raphaël P, ASSIST-ICD Investigators
Аннотация
BACKGROUND: The arrhythmic risk and need for ICD in patients implanted with an LVAD are not very well known.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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).