Predictors and clinical relevance of ventricular tachyarrhythmias in ambulatory patients with a continuous flow left ventricular assist device

Yoruk, Ayhan; Sherazi, Syed Tufail Hussain; Massey, H. Todd; Kutyifa, Valentina; McNitt, Scott; Hallinan, William; Huang, David T.; Chen, Leway; Aktaş, Mehmet K.

doi:10.1016/j.hrthm.2016.01.033

Cited by 61 publications

(41 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Finally, although AAs may be a marker of overall disease burden, this appears less likely given the independence from other comorbidities in predicting decreased survival. 15,16,27,28 The present study is limited by its retrospective nature and is a single-center cohort. The incidence of AAs may be underreported because of a lack of systematic surveillance in this population; however, we found similar incidence of AAs within the subgroup of patients with atrial leads.…”

Section: Discussionmentioning

confidence: 99%

Atrial Arrhythmias and Electroanatomical Remodeling in Patients With Left Ventricular Assist Devices

Deshmukh

Kim

Burke

et al. 2017

JAHA

View full text Add to dashboard Cite

BackgroundThe incidence, predictors, and impact of atrial arrhythmias along with left atrial structural changes in patients with left ventricular assist devices (LVADs) remain undetermined.Methods and ResultsAll patients who underwent LVAD implantation from 2008 to 2015 at the University of Chicago Medical Center were included. Electronic medical records, electrocardiograms, echocardiograms, and cardiac electrical device interrogations were reviewed. The association of arrhythmias and clinical covariates with survival was evaluated by Kaplan–Meier and Cox proportional hazards analyses. A total of 331 patients were followed for a median of 330 days (range 0–2306 days). Mean age was 57.8±12.8 years, 256 participants (77.3%) were male, mean left ventricular ejection fraction was 20±6.6%, and 124 (37.5%) had ischemic cardiomyopathy. Atrial arrhythmias (53.8%) were highly prevalent and frequently coexisted before LVAD implantation: atrial fibrillation (AF) in 45.9%, atrial flutter in 13.9%, atrial tachycardia in 6.9%, and atrioventricular nodal reentrant tachycardia in 1.2%. New‐onset AF was documented in 14 patients (7.8% of patients without prior AF) after the first 30 days with an LVAD. Increasing age, renal insufficiency, and lung disease were predictors of new‐onset AF after LVAD implantation. Of patients with paroxysmal AF, 43% had no further AF after LVAD. Left atrial size and volume index improved with LVAD (P<0.005). History of persistent AF, atrial tachycardia, ventricular arrhythmia, coronary artery bypass, and low albumin were associated with decreased survival.ConclusionsAtrial arrhythmias are significantly prevalent in patients who require LVAD and are associated with increased mortality; however, LVADs induce favorable atrial structural and electrical remodeling.

show abstract

Section: Discussionmentioning

confidence: 99%

Atrial Arrhythmias and Electroanatomical Remodeling in Patients With Left Ventricular Assist Devices

Deshmukh

Kim

Burke

et al. 2017

JAHA

View full text Add to dashboard Cite

show abstract

“…Patients with LVADs carry risk for VTAs, and VTAs are frequently occuring early in the postoperative period [6]. Although the incidence of VTAs in LVAD patients is relatively high, they are often not associated with clinical symptoms or hemodynamic compromise.…”

Section: Risk For Ventricular Arrhythmias In Lvad Patientsmentioning

confidence: 99%

“…In LVAD recipients, however, there remains an increased risk for ventricular tachyarrhythmias (VTAs) that has been shown to adversely impact outcomes [6,7]. Recommendations from the International Society of Hert and Lung Transplantation therefore suggest reactivation of an ICD following an LVAD placement (Class I, Level of Evidence A), and implantation of an ICD in those with no ICD before LVAD (Class IIa, Level of Evidence B) [8], based on small retrospective studies, expert consensus, or meta-analyses [9,10].…”

Section: Introductionmentioning

confidence: 99%

Is there a need for an implantable cardioverter defibrillator in patients with left ventricular assist devices? Time for MADIT-VAD!

Kutyifa

2016

Expert Review of Medical Devices

Self Cite

View full text Add to dashboard Cite

“…Left ventricular assist devices (LVAD) are increasingly utilized to treat end‐stage heart failure (HF) and have been shown to improve survival, either as a bridge to cardiac transplant or as destination therapy . Ventricular arrhythmias (VA) occur in 28% to 52% of patients following LVAD implantation . Postimplant VA has been associated with right HF and increased mortality, and they are more prevalent in patients with older age, nonischemic cardiomyopathy (NICM), preoperative VA, and atrial fibrillation (AF) .…”

Section: Introductionmentioning

confidence: 99%

“…Ventricular arrhythmias (VA) occur in 28% to 52% of patients following LVAD implantation . Postimplant VA has been associated with right HF and increased mortality, and they are more prevalent in patients with older age, nonischemic cardiomyopathy (NICM), preoperative VA, and atrial fibrillation (AF) . Several studies have demonstrated the feasibility of endocardial mapping and ablation after LVAD placement .…”

Section: Introductionmentioning

confidence: 99%

Feasibility and utility of intraoperative epicardial scar characterization during left ventricular assist device implantation

Moss

Oesterle

Raiman

et al. 2018

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Introduction: Ventricular arrhythmias (VA) after left ventricular assist device (LVAD) placement are associated with increased morbidity and mortality.We sought to assess epicardial voltage characteristics at the time of LVAD implantation and investigate relationships between scar burden and postimplant VA. Methods and Results: Consecutive patients underwent open chest epicardial electroanatomic mapping immediately before LVAD implantation. Areas of low voltage and sites with local abnormal potentials were identified. Patients were followed prospectively for postimplant VA and clinical outcomes. Between 2015 and 2017, 36 patients underwent high-density intraoperative epicardial voltage mapping; 15 had complete maps suitable for analysis. Mapping required a median of 11.8 (interquartile range [IQR], 8.5-12.7) minutes, with a median of 2650 (IQR, 2139-3191) points sampled per patient. Over a median follow-up of 311 (IQR, 168-469) postoperative days, four patients (27%) experienced sustained VA. Patients with postimplant VA were more likely to have had preimplant implantable cardioverter defibrillator shocks (100% vs 27%; P = 0.03), ventriculartachycardia storm (75% vs 9%; P = 0.03), and lower ejection fraction (13.5 vs 19.0%, P = 0.05). Patients with postimplant VA also had a significantly higher burden of epicardial low bipolar voltage points: 55.4% vs 24.9% of points were less than 0.5 mV (P = 0.01), and 88.9% vs 63.7% of points less than 1.5 mV (P = 0.004).Conclusions: Intraoperative high-density epicardial mapping during LVAD implantation is safe and efficient, facilitating characterization of a potentially arrhythmogenic substrate. An increased burden of the epicardial scar may be associated with a higher incidence of postimplant VA. The role of empiric

show abstract

Predictors and clinical relevance of ventricular tachyarrhythmias in ambulatory patients with a continuous flow left ventricular assist device

Cited by 61 publications

References 23 publications

Atrial Arrhythmias and Electroanatomical Remodeling in Patients With Left Ventricular Assist Devices

Atrial Arrhythmias and Electroanatomical Remodeling in Patients With Left Ventricular Assist Devices

Is there a need for an implantable cardioverter defibrillator in patients with left ventricular assist devices? Time for MADIT-VAD!

Feasibility and utility of intraoperative epicardial scar characterization during left ventricular assist device implantation

Contact Info

Product

Resources

About