Ventricular arrhythmias were common after getting a continuous-flow left ventricular assist device (LVAD) but didn’t appeared connected to key outcomes, a study found.
Over a median follow-up of 17.3 months, 30.4% of LVAD recipients had ventricular arrhythmia, Sing-Chien Yap, MD, PhD, of Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues reported online in the Journal of the American College of Cardiology.
Yet ventricular arrhythmia was not tied to death (HR 1.10, 95% CI 0.63-1.95), heart transplantation (HR 0.99, 95% CI 0.63-1.55), nor the combination of the two endpoints (HR 0.98, 95% CI 0.69-1.41).
“The lack of mortality association may reflect that the LVAD is able to provide some degree of cardiac output regardless of the underlying cardiac rhythm so that sudden death may be prevented,” Amrut V. Ambardekar, MD, of University of Colorado in Aurora, told MedPage Today.
However, he cautioned, this “should be interpreted cautiously as this was a small study and many of the patients received a heart transplant, which may have attenuated the potential longer-term negative consequences of ventricular arrhythmias.” Ambardekar was not part of Yap’s study.
“This study complements a growing body of work that suggests that ventricular arrhythmias are common after continuous-flow LVAD placement and that LVADs alone do not seem to treat ventricular arrhythmias,” he added. “The larger questions regarding the roles of concomitant implantable cardioverter-defibrillator therapy and/or catheter based ablations of ventricular arrhythmias in LVAD patients remain unanswered but warrant further investigation to optimize outcomes in this patient population.”
Having ventricular arrhythmia before ever getting their LVAD was an independent predictor of getting it again after device placement (adjusted hazard ratio [HR] 2.13, 95% CI 1.06-4.27).
“This is not surprising, because it reflects the presence of an arrhythmogenic substrate that is not abolished by the implantation of an LVAD,” the researchers noted.
Although there was no substantial relationship between death and post-LVAD ventricular arrhythmia, 4.8% of patients had “difficult to control ventricular arrhythmia that required urgent heart transplantation.”
“It is important to realize that in destination-therapy patients with therapy-resistant ventricular arrhythmia, urgent heart transplantation will probably not be a good option,” according to the investigators.
In the retrospective investigation, 204 patients got continuous-flow LVADs between 2006 and 2015 at two Dutch centers. Most cases were intended as a bridge to heart transplantation (93.6%).
The frequency of ventricular arrhythmias followed a U-shaped curve. They were most common in the first month after LVAD implantation (17.6%) and gradually fell to a low in months 15 to 18 (2.7%), before climbing up again thereafter.
“The early ventricular arrhythmias may be related to a combination of inotrope therapy, volume status shifts, variability in LVAD settings, and non-steady state in left ventricular size that are all dynamic variables immediately after LVAD placement surgery,” Ambardekar suggested, while “the late ventricular arrhythmias may reflect the progression of the underlying cardiomyopathy process and possibly right ventricular dysfunction.”
Among the entire study population, 43.1% eventually got a heart transplant and 27.9% died over follow-up. At 1 year, the rates of death and heart transplantation were 11.8% and 18.6%, respectively.
Yap and Ambardekar disclosed no relevant conflicting interests.
One study co-author reported serving as a proctor for Thoratec.
Journal of the American College of Cardiology
Yap S, et al “Ventricular arrhythmias in patients with a continuous-flow left ventricular assist device” J Am Coll Cardiol 2016; DOI: 10.1016/j.jacc.2016.05.016.