Prolonged Repolarization After Ventricular Assist Device Support Is Associated With Arrhythmias in Humans With Congestive Heart Failure

Harding, John J.; Piacentino, Valentino; Rothman, Steven A.; Chambers, Susan; Jessup, Mariell; Margulies, Kenneth B.

doi:10.1016/j.cardfail.2004.08.158

Cited by 65 publications

(53 citation statements)

References 21 publications

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“…6 Similar findings have been seen in single-center observational studies, where VA have been reported to occur in 22% to 59% of LVAD recipients (Table). 6,[10][11][12][13][14][15][16][17][18] Incident VAs are also seen in patients who have not had VA before LVAD implant. Ziv et al 14 retrospectively studied 91 consecutive patients who underwent implant of a firstgeneration Heartmate XVE device.…”

Section: Epidemiologymentioning

confidence: 99%

“…Other investigators have also reported similar findings, with VA occurring frequently during the early postoperative period and decreasing over the longer term. 16,19 Mechanisms of VA in early and late postoperative periods have not been elucidated, but it is likely that perioperative adrenergic stimulation and the use of adrenergic agonists may play an important role in promoting early arrhythmias, whereas positive cardiac remodeling on LVAD support may be important in decreased VA later during followup. It is also important to note that although the majority of arrhythmias occur early, limited data suggest that a quarter to a third of patients may experience their first VA after 30 days.…”

Section: Epidemiologymentioning

confidence: 99%

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Ventricular Arrhythmias After Left Ventricular Assist Device

Nakahara

Chien

Gelow

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Ventricular Arrhythmias After Left Ventricular Assist Device

Nakahara

Chien

Gelow

et al. 2013

Circ: Arrhythmia and Electrophysiology

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“…[3][4][5] Large epidemiological studies, such as the REMATCH study, demonstrated that the employment of LVAD significantly improved survival rate and the quality of life, in comparison to optimal medical management. 6 An early postoperative period study after cardiac unloading therapy in 17 HF patients showed that in the first two weeks after LVAD implantation, HF was associated with a relatively high incidence of ventricular arrhythmias associated with QTc interval prolongation 7 . In addition, a recent retrospective study of 100 adult patients with advanced HF, treated with an axial-flow HeartMate LVAD suggested that the rate of new-onset monomorphic ventricular tachycardia (MVT) was increased in LVADtreated patients compared to patients given only medical treatment, while no effect was observed on the development of polymorphic ventricular tachycardia (PVT)/ventricular fibrillation (VF) 8 .…”

mentioning

confidence: 99%

Cytoskeletal Basis of Ion Channel Function in Cardiac Muscle

Vatta

Faulkner

2006

Future Cardiol.

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SummaryThe heart is a force-generating organ that responds to self-generated electrical stimuli from specialized cardiomyocytes. This function is modulated by sympathetic and parasympathetic activity.In order to contract and accommodate the repetitive morphological changes induced by the cardiac cycle, cardiomyocytes depend on their highly evolved and specialized cytoskeletal apparatus. Defects in components of the cytoskeleton, in the long term, affect the ability of the cell to compensate at both functional and structural levels. In addition to the structural remodeling, the myocardium becomes increasingly susceptible to altered electrical activity leading to arrhythmogenesis. The development of arrhythmias secondary to structural remodeling defects has been noted, although the detailed molecular mechanisms are still elusive. Here I will review the current knowledge of the molecular and functional relationships between the cytoskeleton and ion channels and, I will discuss the future impact of new data on molecular cardiology research and clinical practice.

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“…Some investigators have demonstrated greater rates of arrhythmic events among patients with ischaemic heart disease, 10,11 while others have suggested that non-ischaemic patients are at higher risk. 8 The absence of postoperative beta-blocker therapy, 12 prolongation of the baseline QT interval, 13 and deranged serum electrolytes have all been touted as risk factors as well, 11 but none of these have been well validated. In fact, only the presence of pre-implantation ventricular tachycardia (VT) has been repeatedly shown to be a powerful predictor of future episodes of VT after LVAD.…”

Section: Epidemiology and Aetiology Of Ventricular Arrhythmias Duringmentioning

confidence: 99%

“…15 While some studies have shown that after sustained LVAD support there is a shortening of the action potential duration and reduction in the QT interval, occurring in parallel with phenotypic ventricular reverse-remodelling, others have demonstrated a paradoxical QT prolongation in the first week following LVAD implantation, and have suggested that these acute repolarisation abnormalities may trigger early ventricular arrhythmias in the LVAD patient. 13 Finally, the influence of myocardial scar has also received considerable attention as a substrate for post-device ventricular arrhythmias. The resulting re-entrant VT is a common cause of morbidity and mortality in patients with advanced heart failure, and remains a potent mechanism for VT even after LVAD placement.…”

Section: Epidemiology and Aetiology Of Ventricular Arrhythmias Duringmentioning

confidence: 99%

The Burden of Ventricular Arrhythmias Following Left Ventricular Assist Device Implantation

Griffin¹,

Katz²

2014

Arrhythm Electrophysiol Rev

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Prior to the widespread availability of left ventricular assist devices (LVADs), many end-stage heart failure patients were forced to fight over scarce transplant resources or face the reality of impending death. For those considered transplant-ineligible, due to medical or psychosocial factors, symptom palliation and end-of-life care were the only available options. This all changed dramatically following the publication of the landmark Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial, 1 a multicentre investigation designed to determine the impact of a pulsatile LVAD compared with optimal pharmacotherapy in a high-risk cohort of patients with advanced disease. Boasting a remarkable 48 % reduction in mortality with LVAD support, 1 the results of this study promptly ushered in a historic evolution in mechanical circulatory support. Now, little more than a decade after REMATCH was presented, more than 10,000 patients have been implanted with a durable LVAD.2 Novel design changes have ensued, such that modern devices are substantially smaller and no longer pulsatile. By embracing continuous-flow technology, the field has seen incremental gains in patient survival and quality of life. Currently, over 80 % of patients are alive at one year, while two-year survival following device implantation now exceeds 70 per cent. With this in mind, the following review will highlight the epidemiology, symptomatology, complications and management goals for ventricular arrhythmias in the contemporary LVAD era. Evolution of Ventricular Assist Device TherapyFrom a historical perspective, LVADs have evolved considerably in a relatively short period of time. Initial first-generation LVADs were designed to be volume-displacement pumps. They provided pulsatile flow, as a blood-containing chamber would fill and then empty in concert with the heart's native contraction. These pumps were relatively large and required a number of moving parts in order to function optimally.As a result, they were difficult to implant in smaller patients and were prone to wear over time. In order to overcome some of these limitations, second generation LVADs employed continuous-flow technology through the use of an axial rotor. These devices were considerably smaller, could be implanted in a broader population of patients, and demonstrated enhanced durability. In addition, systemic pulsatility was abandoned in exchange for continuous ventricular unloading. Newer third-generation devices -designed with either hydrodynamically-or magnetically-elevated rotors -now provide cardiac support to advanced heart failure patients via centrifugal flow. Though they have only recently been introduced into the marketplace, and are currently the subject of ongoing investigation, implant volumes for these novel LVADs have been AbstractFew innovations in medicine have so convincingly and expeditiously improved patient outcomes more than the development of the left ventricular assist device (LVAD). Where optimal pharma...

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Prolonged Repolarization After Ventricular Assist Device Support Is Associated With Arrhythmias in Humans With Congestive Heart Failure

Cited by 65 publications

References 21 publications

Ventricular Arrhythmias After Left Ventricular Assist Device

Ventricular Arrhythmias After Left Ventricular Assist Device

Cytoskeletal Basis of Ion Channel Function in Cardiac Muscle

The Burden of Ventricular Arrhythmias Following Left Ventricular Assist Device Implantation

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