Early post-operative ventricular arrhythmias in patients with continuous-flow left ventricular assist devices

Arthur R. Garan, Allison P. Levin, Veli Topkara, Sunu S. Thomas, Melana Yuzefpolskaya, Paolo C. Colombo, Koji Takeda, Hiroo Takayama, Yoshifumi Naka, William Whang, Ulrich P. Jorde, Nir Uriel

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background Ventricular arrhythmias (VAs) are common in patients with a continuous-flow left ventricular assist device (CF-LVAD). The causes and clinical significance of early post-operative VAs have not previously been characterized in these patients. The purpose of this study was to assess the incidence, precipitants, and clinical impact of early VAs in patients supported by CF-LVADs. Methods Patients with a long-term CF-LVAD receiving care between January 1, 2012, and March 1, 2014, were enrolled and followed prospectively. Implantable cardioverter-defibrillators (ICDs) were interrogated at baseline and throughout the follow-up period. VA was defined as ventricular tachycardia or ventricular fibrillation lasting >30 seconds or effectively terminated by appropriate ICD tachytherapy or external defibrillation. The primary end-point was the occurrence of early VAs (within 30 days of surgery). Secondary end-points were right ventricular (RV) failure and need for VA ablation. Results There were 162 patients enrolled, and 38 (23.5%) experienced at least 1 early VA. Predictors of early VA were a history of pre-operative VAs, non-ischemic cardiomyopathy, and older age. Several conditions frequently encountered in the early post-operative period were identified as possible precipitants for VA episodes. Early VAs were associated with post-operative RV failure, particularly when patients received shocks instead of anti-tachycardia pacing. Conclusions Early VAs are common and are associated with RV failure. ICD shocks, but not anti-tachycardia pacing, for early VAs are associated with acute worsening of RV failure.

Original languageEnglish (US)
Pages (from-to)1611-1616
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume34
Issue number12
DOIs
StatePublished - Dec 1 2015

Fingerprint

Heart-Assist Devices
Cardiac Arrhythmias
Implantable Defibrillators
Tachycardia
Shock
Ventricular Fibrillation
Ventricular Tachycardia
Ambulatory Surgical Procedures
Cardiomyopathies

Keywords

  • ablation
  • ICD
  • LVAD
  • right ventricular failure
  • suction event
  • ventricular arrhythmia
  • ventricular tachycardia

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Garan, A. R., Levin, A. P., Topkara, V., Thomas, S. S., Yuzefpolskaya, M., Colombo, P. C., ... Uriel, N. (2015). Early post-operative ventricular arrhythmias in patients with continuous-flow left ventricular assist devices. Journal of Heart and Lung Transplantation, 34(12), 1611-1616. https://doi.org/10.1016/j.healun.2015.05.018

Early post-operative ventricular arrhythmias in patients with continuous-flow left ventricular assist devices. / Garan, Arthur R.; Levin, Allison P.; Topkara, Veli; Thomas, Sunu S.; Yuzefpolskaya, Melana; Colombo, Paolo C.; Takeda, Koji; Takayama, Hiroo; Naka, Yoshifumi; Whang, William; Jorde, Ulrich P.; Uriel, Nir.

In: Journal of Heart and Lung Transplantation, Vol. 34, No. 12, 01.12.2015, p. 1611-1616.

Research output: Contribution to journalArticle

Garan, AR, Levin, AP, Topkara, V, Thomas, SS, Yuzefpolskaya, M, Colombo, PC, Takeda, K, Takayama, H, Naka, Y, Whang, W, Jorde, UP & Uriel, N 2015, 'Early post-operative ventricular arrhythmias in patients with continuous-flow left ventricular assist devices', Journal of Heart and Lung Transplantation, vol. 34, no. 12, pp. 1611-1616. https://doi.org/10.1016/j.healun.2015.05.018
Garan, Arthur R. ; Levin, Allison P. ; Topkara, Veli ; Thomas, Sunu S. ; Yuzefpolskaya, Melana ; Colombo, Paolo C. ; Takeda, Koji ; Takayama, Hiroo ; Naka, Yoshifumi ; Whang, William ; Jorde, Ulrich P. ; Uriel, Nir. / Early post-operative ventricular arrhythmias in patients with continuous-flow left ventricular assist devices. In: Journal of Heart and Lung Transplantation. 2015 ; Vol. 34, No. 12. pp. 1611-1616.
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abstract = "Background Ventricular arrhythmias (VAs) are common in patients with a continuous-flow left ventricular assist device (CF-LVAD). The causes and clinical significance of early post-operative VAs have not previously been characterized in these patients. The purpose of this study was to assess the incidence, precipitants, and clinical impact of early VAs in patients supported by CF-LVADs. Methods Patients with a long-term CF-LVAD receiving care between January 1, 2012, and March 1, 2014, were enrolled and followed prospectively. Implantable cardioverter-defibrillators (ICDs) were interrogated at baseline and throughout the follow-up period. VA was defined as ventricular tachycardia or ventricular fibrillation lasting >30 seconds or effectively terminated by appropriate ICD tachytherapy or external defibrillation. The primary end-point was the occurrence of early VAs (within 30 days of surgery). Secondary end-points were right ventricular (RV) failure and need for VA ablation. Results There were 162 patients enrolled, and 38 (23.5{\%}) experienced at least 1 early VA. Predictors of early VA were a history of pre-operative VAs, non-ischemic cardiomyopathy, and older age. Several conditions frequently encountered in the early post-operative period were identified as possible precipitants for VA episodes. Early VAs were associated with post-operative RV failure, particularly when patients received shocks instead of anti-tachycardia pacing. Conclusions Early VAs are common and are associated with RV failure. ICD shocks, but not anti-tachycardia pacing, for early VAs are associated with acute worsening of RV failure.",
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AU - Garan, Arthur R.

AU - Levin, Allison P.

AU - Topkara, Veli

AU - Thomas, Sunu S.

AU - Yuzefpolskaya, Melana

AU - Colombo, Paolo C.

AU - Takeda, Koji

AU - Takayama, Hiroo

AU - Naka, Yoshifumi

AU - Whang, William

AU - Jorde, Ulrich P.

AU - Uriel, Nir

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N2 - Background Ventricular arrhythmias (VAs) are common in patients with a continuous-flow left ventricular assist device (CF-LVAD). The causes and clinical significance of early post-operative VAs have not previously been characterized in these patients. The purpose of this study was to assess the incidence, precipitants, and clinical impact of early VAs in patients supported by CF-LVADs. Methods Patients with a long-term CF-LVAD receiving care between January 1, 2012, and March 1, 2014, were enrolled and followed prospectively. Implantable cardioverter-defibrillators (ICDs) were interrogated at baseline and throughout the follow-up period. VA was defined as ventricular tachycardia or ventricular fibrillation lasting >30 seconds or effectively terminated by appropriate ICD tachytherapy or external defibrillation. The primary end-point was the occurrence of early VAs (within 30 days of surgery). Secondary end-points were right ventricular (RV) failure and need for VA ablation. Results There were 162 patients enrolled, and 38 (23.5%) experienced at least 1 early VA. Predictors of early VA were a history of pre-operative VAs, non-ischemic cardiomyopathy, and older age. Several conditions frequently encountered in the early post-operative period were identified as possible precipitants for VA episodes. Early VAs were associated with post-operative RV failure, particularly when patients received shocks instead of anti-tachycardia pacing. Conclusions Early VAs are common and are associated with RV failure. ICD shocks, but not anti-tachycardia pacing, for early VAs are associated with acute worsening of RV failure.

AB - Background Ventricular arrhythmias (VAs) are common in patients with a continuous-flow left ventricular assist device (CF-LVAD). The causes and clinical significance of early post-operative VAs have not previously been characterized in these patients. The purpose of this study was to assess the incidence, precipitants, and clinical impact of early VAs in patients supported by CF-LVADs. Methods Patients with a long-term CF-LVAD receiving care between January 1, 2012, and March 1, 2014, were enrolled and followed prospectively. Implantable cardioverter-defibrillators (ICDs) were interrogated at baseline and throughout the follow-up period. VA was defined as ventricular tachycardia or ventricular fibrillation lasting >30 seconds or effectively terminated by appropriate ICD tachytherapy or external defibrillation. The primary end-point was the occurrence of early VAs (within 30 days of surgery). Secondary end-points were right ventricular (RV) failure and need for VA ablation. Results There were 162 patients enrolled, and 38 (23.5%) experienced at least 1 early VA. Predictors of early VA were a history of pre-operative VAs, non-ischemic cardiomyopathy, and older age. Several conditions frequently encountered in the early post-operative period were identified as possible precipitants for VA episodes. Early VAs were associated with post-operative RV failure, particularly when patients received shocks instead of anti-tachycardia pacing. Conclusions Early VAs are common and are associated with RV failure. ICD shocks, but not anti-tachycardia pacing, for early VAs are associated with acute worsening of RV failure.

KW - ablation

KW - ICD

KW - LVAD

KW - right ventricular failure

KW - suction event

KW - ventricular arrhythmia

KW - ventricular tachycardia

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