Does Preoperative Atrial Fibrillation Increase the Incidence of Thromboembolic Complications in Patients Supported with Long-Term LVADs?

Abstract

Purpose: We reviewed our nine year experience of continuous flow left ventricular assist devices (LVADs) to determine the impact of preoperative atrial fibrillation (AF) on stroke, device thrombosis, and survival. Methods: Between March 2006 and May 2015, 231 patients underwent implantation of 240 CF LVADs -127 (52.9%) as bridge to transplant (BTT) and 113 (47.1%) as destination therapy (DT). Effect of AF on postoperative outcomes was assessed by using Kaplan Meier survival and Cox proportional hazard regression. Results: There were 78 (32.5%) patients with preoperative AF with a mean age of 55.7 + 11.4 years. There was a similar incidence of stroke in patients with and without AF -12.8% versus 16.0%, respectively (p= 0.803). The incidence of device exchange for thrombosis was also similar in both groups (3.9% vs. 3.7%; p= 0.999). Survival was similar, with 1-month, 6-month, 12-month, and 24-month survivals of 96.2%, 91.7%, 84.5%, and 69.2%, respectively, for AF patients, versus 93.1%, 85.0%, 79.4%, and 74.1%, respectively, for non-AF patients (p= 0.424). Preoperative AF was not a significant independent predictor of survival using Cox proportional hazard regression (HR 1.08, 95% CI 0.66-1.76). Conclusion: Preoperative AF was associated with a similar incidence of postoperative stroke, device thrombosis, and survival. Based on these data, it seems unnecessary to perform a left atrial appendage ligation or alter postoperative anticoagulation in patients with AF undergoing LVAD implantation.