Ventricular arrhythmias and implantable cardioverter-defibrillator therapy in patients with continuous-flow left ventricular assist devices: Need for primary prevention?

Arthur R. Garan, Melana Yuzefpolskaya, Paolo C. Colombo, John P. Morrow, Rosie Te-Frey, Drew Dano, Hiroo Takayama, Yoshifumi Naka, Hasan Garan, Ulrich P. Jorde, Nir Uriel

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

Objectives This study sought to evaluate the prevalence and significance of ventricular arrhythmia (VA) and the role of an implantable cardioverter- defibrillator (ICD) in patients supported by a continuous-flow left ventricular assist device (CF-LVAD). Background VAs are common in patients supported by CF-LVADs but prospective data to support the routine use of ICDs in these patients are lacking. Methods All patients supported by long-term CF-LVAD receiving care at our institution were enrolled. The ICDs were interrogated at baseline and throughout prospective follow-up. The VA was defined as ventricular tachycardia/fibrillation lasting >30 s or effectively terminated by appropriate ICD tachytherapy. The primary outcome was the occurrence of VA >30 days after CF-LVAD implantation. Results Ninety-four patients were enrolled; 77 had an ICD and 17 did not. Five patients with an ICD had it deactivated or a depleted battery not replaced during the study. Twenty-two patients had a VA >30 days after LVAD implantation. Pre-operative VA was the major predictor of post-operative arrhythmia. Absence of pre-operative VA conferred a low risk of post-operative VA (4.0% vs. 45.5%; p < 0.001). No patients discharged from the hospital without an ICD after CF-LVAD implantation died during 276.2 months of follow-up (mean time without ICD, 12.7 ± 12.3 months). Conclusions Patients with pre-operative VA are at risk of recurrent VA while on CF-LVAD support and should have active ICD therapy to minimize sustained VA. Patients without pre-operative VA are at low risk and may not need active ICD therapy.

Original languageEnglish (US)
Pages (from-to)2542-2550
Number of pages9
JournalJournal of the American College of Cardiology
Volume61
Issue number25
DOIs
StatePublished - Jun 25 2013
Externally publishedYes

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Heart-Assist Devices
Implantable Defibrillators
Primary Prevention
Cardiac Arrhythmias
Therapeutics
Ventricular Fibrillation
Ventricular Tachycardia

Keywords

  • heart failure
  • implantable cardioverter-defibrillator
  • left ventricular assist device
  • ventricular arrhythmia
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ventricular arrhythmias and implantable cardioverter-defibrillator therapy in patients with continuous-flow left ventricular assist devices : Need for primary prevention? / Garan, Arthur R.; Yuzefpolskaya, Melana; Colombo, Paolo C.; Morrow, John P.; Te-Frey, Rosie; Dano, Drew; Takayama, Hiroo; Naka, Yoshifumi; Garan, Hasan; Jorde, Ulrich P.; Uriel, Nir.

In: Journal of the American College of Cardiology, Vol. 61, No. 25, 25.06.2013, p. 2542-2550.

Research output: Contribution to journalArticle

Garan, Arthur R. ; Yuzefpolskaya, Melana ; Colombo, Paolo C. ; Morrow, John P. ; Te-Frey, Rosie ; Dano, Drew ; Takayama, Hiroo ; Naka, Yoshifumi ; Garan, Hasan ; Jorde, Ulrich P. ; Uriel, Nir. / Ventricular arrhythmias and implantable cardioverter-defibrillator therapy in patients with continuous-flow left ventricular assist devices : Need for primary prevention?. In: Journal of the American College of Cardiology. 2013 ; Vol. 61, No. 25. pp. 2542-2550.
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title = "Ventricular arrhythmias and implantable cardioverter-defibrillator therapy in patients with continuous-flow left ventricular assist devices: Need for primary prevention?",
abstract = "Objectives This study sought to evaluate the prevalence and significance of ventricular arrhythmia (VA) and the role of an implantable cardioverter- defibrillator (ICD) in patients supported by a continuous-flow left ventricular assist device (CF-LVAD). Background VAs are common in patients supported by CF-LVADs but prospective data to support the routine use of ICDs in these patients are lacking. Methods All patients supported by long-term CF-LVAD receiving care at our institution were enrolled. The ICDs were interrogated at baseline and throughout prospective follow-up. The VA was defined as ventricular tachycardia/fibrillation lasting >30 s or effectively terminated by appropriate ICD tachytherapy. The primary outcome was the occurrence of VA >30 days after CF-LVAD implantation. Results Ninety-four patients were enrolled; 77 had an ICD and 17 did not. Five patients with an ICD had it deactivated or a depleted battery not replaced during the study. Twenty-two patients had a VA >30 days after LVAD implantation. Pre-operative VA was the major predictor of post-operative arrhythmia. Absence of pre-operative VA conferred a low risk of post-operative VA (4.0{\%} vs. 45.5{\%}; p < 0.001). No patients discharged from the hospital without an ICD after CF-LVAD implantation died during 276.2 months of follow-up (mean time without ICD, 12.7 ± 12.3 months). Conclusions Patients with pre-operative VA are at risk of recurrent VA while on CF-LVAD support and should have active ICD therapy to minimize sustained VA. Patients without pre-operative VA are at low risk and may not need active ICD therapy.",
keywords = "heart failure, implantable cardioverter-defibrillator, left ventricular assist device, ventricular arrhythmia, ventricular tachycardia",
author = "Garan, {Arthur R.} and Melana Yuzefpolskaya and Colombo, {Paolo C.} and Morrow, {John P.} and Rosie Te-Frey and Drew Dano and Hiroo Takayama and Yoshifumi Naka and Hasan Garan and Jorde, {Ulrich P.} and Nir Uriel",
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T1 - Ventricular arrhythmias and implantable cardioverter-defibrillator therapy in patients with continuous-flow left ventricular assist devices

T2 - Need for primary prevention?

AU - Garan, Arthur R.

AU - Yuzefpolskaya, Melana

AU - Colombo, Paolo C.

AU - Morrow, John P.

AU - Te-Frey, Rosie

AU - Dano, Drew

AU - Takayama, Hiroo

AU - Naka, Yoshifumi

AU - Garan, Hasan

AU - Jorde, Ulrich P.

AU - Uriel, Nir

PY - 2013/6/25

Y1 - 2013/6/25

N2 - Objectives This study sought to evaluate the prevalence and significance of ventricular arrhythmia (VA) and the role of an implantable cardioverter- defibrillator (ICD) in patients supported by a continuous-flow left ventricular assist device (CF-LVAD). Background VAs are common in patients supported by CF-LVADs but prospective data to support the routine use of ICDs in these patients are lacking. Methods All patients supported by long-term CF-LVAD receiving care at our institution were enrolled. The ICDs were interrogated at baseline and throughout prospective follow-up. The VA was defined as ventricular tachycardia/fibrillation lasting >30 s or effectively terminated by appropriate ICD tachytherapy. The primary outcome was the occurrence of VA >30 days after CF-LVAD implantation. Results Ninety-four patients were enrolled; 77 had an ICD and 17 did not. Five patients with an ICD had it deactivated or a depleted battery not replaced during the study. Twenty-two patients had a VA >30 days after LVAD implantation. Pre-operative VA was the major predictor of post-operative arrhythmia. Absence of pre-operative VA conferred a low risk of post-operative VA (4.0% vs. 45.5%; p < 0.001). No patients discharged from the hospital without an ICD after CF-LVAD implantation died during 276.2 months of follow-up (mean time without ICD, 12.7 ± 12.3 months). Conclusions Patients with pre-operative VA are at risk of recurrent VA while on CF-LVAD support and should have active ICD therapy to minimize sustained VA. Patients without pre-operative VA are at low risk and may not need active ICD therapy.

AB - Objectives This study sought to evaluate the prevalence and significance of ventricular arrhythmia (VA) and the role of an implantable cardioverter- defibrillator (ICD) in patients supported by a continuous-flow left ventricular assist device (CF-LVAD). Background VAs are common in patients supported by CF-LVADs but prospective data to support the routine use of ICDs in these patients are lacking. Methods All patients supported by long-term CF-LVAD receiving care at our institution were enrolled. The ICDs were interrogated at baseline and throughout prospective follow-up. The VA was defined as ventricular tachycardia/fibrillation lasting >30 s or effectively terminated by appropriate ICD tachytherapy. The primary outcome was the occurrence of VA >30 days after CF-LVAD implantation. Results Ninety-four patients were enrolled; 77 had an ICD and 17 did not. Five patients with an ICD had it deactivated or a depleted battery not replaced during the study. Twenty-two patients had a VA >30 days after LVAD implantation. Pre-operative VA was the major predictor of post-operative arrhythmia. Absence of pre-operative VA conferred a low risk of post-operative VA (4.0% vs. 45.5%; p < 0.001). No patients discharged from the hospital without an ICD after CF-LVAD implantation died during 276.2 months of follow-up (mean time without ICD, 12.7 ± 12.3 months). Conclusions Patients with pre-operative VA are at risk of recurrent VA while on CF-LVAD support and should have active ICD therapy to minimize sustained VA. Patients without pre-operative VA are at low risk and may not need active ICD therapy.

KW - heart failure

KW - implantable cardioverter-defibrillator

KW - left ventricular assist device

KW - ventricular arrhythmia

KW - ventricular tachycardia

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