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

107 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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