Atrial fibrillation in mechanical circulatory support patients

Abstract

Atrial fibrillation (AF) is known to be one of the most common arrhythmias noted in cardiac procedures and is frequently associated with heart failure. As frequent interventions for patients with heart failure involve implantation of mechanical circulatory assist devices (e.g., left ventricular assist devices), it is timely to review the role this arrhythmia has on adverse clinical outcomes. A comprehensive literature search was conducted for PubMed. Relevant medical subject heading (MeSH) terms used in the initial literature search include “Heart-Assist Devices”, “Extracorporeal Membrane Oxygenation”, “Atrial Fibrillation”, “Heart Failure”, “Mortality”, “Hospital Readmission”, “stroke”, “Postoperative Complications”. In this review, the relevant literature was highlighted to identify the incidence, clinical impacts, and management of AF surrounding mechanical circulatory support implantation. The incidence of AF in this mechanical circulatory support device population was similar to that of patients with other cardiac procedures (10%-40%). Moreover, in most studies, preoperative AF was not significantly associated with adverse outcomes. In contrast, however, it appears that postoperative atrial fibrillation may predispose patients to increased risk for thromboembolic events and adverse long-term outcomes.

Editorial review: guidance for future atrial fibrillation research

“…Although many publications on first-time aortic valve replacement and repair procedures (AVR) and the association with POAF exist, a paucity of knowledge persists regarding the POAF impact upon repeat aortic valve replacement (r-AVR) procedural patients' outcomes and resource utilization; additionally, the risk factors associated with r-AVR patients' new-onset POAF complications have not been well studied. To address this knowledge gap, Dokko's research team utilized the New York State's SPARCS database for r-AVR patients' records from 2005-2018; using these r-AVR records, new multivariable models identified the factors associated with new-onset POAF complications, as well as POAF's impact upon risk-adjusted outcomes including a mortality/morbidity composite (comprised of 30-day operative mortality and/or major morbidity) and 30-day readmission [16] .…”

“…Enhanced POAF risk was found for the elderly (i.e., age = 80+) and cerebral vascular disease r-AVR patients. As POAF was associated with increased rates of 30-day readmission but no increased composite endpoint rates, additional r-AVR research now appears warranted to improve POAF patients' post-discharge continuity of care to prevent future readmissions [16] .…”