Skip to main content

Advertisement

SpringerLink
Log in

ICD shocks in LVAD patients are not associated with increased subsequent mortality risk

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Implantable cardioverter-defibrillator (ICD) shocks are associated with increased mortality risk in heart failure patients. Whether ICD shocks are associated with mortality in continuous flow LVAD (CF-LVAD) patients is unknown. We studied the relationship of ICD shocks and ventricular arrhythmias (VAs) to morbidity and mortality in CF-LVAD-supported patients in our institution.

Methods

Single-center, retrospective study of prospectively collected ICD and LVAD databases. We analyzed data on VA which received ICD therapy in patients who underwent CF-LVAD implantation at Hartford Hospital between 2008 and 2018.

Results

A total of 157 patients were studied. During a median follow-up of 10 months (interquartile range 5–20 months), 48 patients (30.6%) experienced post-LVAD sustained VA. Thirty patients (19.1%) had appropriate shocks for VA and 5 patients (3.1%) had inappropriate shocks. Shocks for any arrhythmia were not associated with an increased risk of death (OR 0.836, 95% CI 0.224–3.115, p = 0.789). Neither post-LVAD VA nor the rate of VA was associated with an increased mortality risk (OR 0.662 [0.329–1.334], p = 0.248; OR 1.001 [0.989–1.014], p = 0.817, respectively). Cox multivariate regression analysis revealed pre-LVAD VA as a significant predictor of VA post LVAD implantation (OR 3.284 [1.584–6.808], p = 0.001). Symptoms with VA occurred in 22 (45.8%) patients, ranging from palpitations to near syncope/syncope. None of the variables including the rate of VA was associated with death or symptoms.

Conclusions

VAs are common in CF-LVAD patients and occur with higher frequency in those with pre-LVAD VA and frequently cause symptoms. Neither VA nor ICD shocks are associated with mortality risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

LVAD:

Left ventricular assist device

VA:

Ventricular arrhythmia

DT:

Destination therapy

BTT:

Bridge to transplant

BTD:

Bridge to decision

ATP:

Anti-tachycardia pacing

References

  1. Connolly SJ, Hallstrom AP, Cappato R, Schron EB, Kuck KH, Zipes DP, et al. Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials. AVID, CASH and CIDS studies. Antiarrhythmics vs Implantable Defibrillator study. Cardiac Arrest Study Hamburg . Canadian Implantable Defibrillator Study. Eur Heart J. 2000;21:2071–8.

    Article  CAS  Google Scholar 

  2. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877–83.

    Article  Google Scholar 

  3. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352:225–37.

    Article  CAS  Google Scholar 

  4. Sweeney MO, Sherfesee L, DeGroot PJ, Wathen MS, Wilkoff BL. Differences in effects of electrical therapy type for ventricular arrhythmias on mortality in implantable cardioverter-defibrillator patients. Heart Rhythm. 2010;7:353–60.

    Article  Google Scholar 

  5. Daubert JP, Zareba W, Cannom DS, McNitt S, Rosero SZ, Wang P, et al. Inappropriate implantable cardioverter-defibrillator shocks in MADIT II: frequency, mechanisms, predictors, and survival impact. J Am Coll Cardiol. 2008;51:1357–65.

    Article  Google Scholar 

  6. Poole JE, Johnson GW, Hellkamp AS, Anderson J, Callans DJ, Raitt MH, et al. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med. 2008;359:1009–17.

    Article  CAS  Google Scholar 

  7. Cantillon DJ, Tarakji KG, Kumbhani DJ, Smedira NG, Starling RC, Wilkoff BL. Improved survival among ventricular assist device recipients with a concomitant implantable cardioverter-defibrillator. Heart Rhythm. 2010;7:466–71.

    Article  Google Scholar 

  8. Refaat MM, Tanaka T, Kormos RL, McNamara D, Teuteberg J, Winowich S, et al. Survival benefit of implantable cardioverter-defibrillators in left ventricular assist device-supported heart failure patients. J Card Fail. 2012;18:140–5.

    Article  Google Scholar 

  9. Vakil K, Kazmirczak F, Sathnur N, Adabag S, Cantillon DJ, Kiehl EL, et al. Implantable cardioverter-defibrillator use in patients with left ventricular assist devices: a systematic review and meta-analysis. JACC Heart Fail. 2016;4:772–9.

    Article  Google Scholar 

  10. Garan AR, Yuzefpolskaya M, Colombo PC, Morrow JP, Te-Frey R, Dano D, et al. Ventricular arrhythmias and implantable cardioverter-defibrillator therapy in patients with continuous-flow left ventricular assist devices: need for primary prevention? J Am Coll Cardiol. 2013;61:2542–50.

    Article  Google Scholar 

  11. Enriquez AD, Calenda B, Miller MA, Anyanwu AC, Pinney SP. The role of implantable cardioverter-defibrillators in patients with continuous flow left ventricular assist devices. Circ Arrhythm Electrophysiol. 2013;6:668–74.

    Article  CAS  Google Scholar 

  12. Lee W, Tay A, Subbiah RN, Walker BD, Kuchar DL, Muthiah K, et al. Impact of implantable cardioverter defibrillators on survival of patients with centrifugal left ventricular assist devices. Pacing Clin Electrophysiol. 2015;38:925–33.

    Article  Google Scholar 

  13. Vakil K, Duval S, Cogswell R, Eckman P, Levy WC, Anand I, et al. Impact of implantable cardioverter-defibrillators on waitlist mortality among patients awaiting heart transplantation: an UNOS/OPTN analysis. JACC Clin Electrophysiol. 2017;3:33–40.

    Article  Google Scholar 

  14. Bedi M, Kormos R, Winowich S, McNamara DM, Mathier MA, Murali S. Ventricular arrhythmias during left ventricular assist device support. Am J Cardiol. 2007;99:1151–3.

    Article  Google Scholar 

  15. Ziv O, Dizon J, Thosani A, Naka Y, Magnano AR, Garan H. Effects of left ventricular assist device therapy on ventricular arrhythmias. J Am Coll Cardiol. 2005;45:1428–34.

    Article  Google Scholar 

  16. Andersen M, Videbaek R, Boesgaard S, Sander K, Hansen PB, Gustafsson F. Incidence of ventricular arrhythmias in patients on long-term support with a continuous-flow assist device (HeartMate II). J Heart Lung Transplant. 2009;28:733–5.

    Article  Google Scholar 

  17. Refaat M, Chemaly E, Lebeche D, Gwathmey JK, Hajjar RJ. Ventricular arrhythmias after left ventricular assist device implantation. Pacing Clin Electrophysiol. 2008;31:1246–52.

    Article  Google Scholar 

  18. Ambardekar AV, Allen LA, Lindenfeld J, Lowery CM, Cannon AP, Cleveland JC, et al. Implantable cardioverter-defibrillator shocks in patients with a left ventricular assist device. J Heart Lung Transplant. 2010;29:771–6.

    Article  Google Scholar 

  19. Efimova E, Fischer J, Bertagnolli L, Dinov B, Kircher S, Rolf S, et al. Predictors of ventricular arrhythmia after left ventricular assist device implantation: a large single-center observational study. Heart Rhythm. 2017;14:1812–9.

    Article  Google Scholar 

  20. Greet BD, Pujara D, Burkland D, Pollet M, Sudhakar D, Rojas F, et al. Incidence, predictors, and significance of ventricular arrhythmias in patients with continuous-flow left ventricular assist devices: a 15-year institutional experience. JACC Clin Electrophysiol. 2018;4:257–64.

    Article  Google Scholar 

  21. Yoruk A, Sherazi S, Massey HT, Kutyifa V, McNitt S, Hallinan W, et al. Predictors and clinical relevance of ventricular tachyarrhythmias in ambulatory patients with a continuous flow left ventricular assist device. Heart Rhythm. 2016;13:1052–6.

    Article  Google Scholar 

  22. Healy C, Viles-Gonzalez JF, Sacher F, Coffey JO, d’Avila A. Management of ventricular arrhythmias in patients with mechanical ventricular support devices. Curr Cardiol Rep. 2015;17:59–015.

    Article  Google Scholar 

  23. Fitzgibbon J, Kman NE, Gorgas D. Asymptomatic sustained polymorphic ventricular tachycardia in a patient with a left ventricular assist device: case report and what the emergency physician should know. J Emerg Med. 2016;50:e135–41.

    Article  Google Scholar 

  24. Cantillon DJ, Saliba WI, Wazni OM, Kanj M, Starling RC, Tang WH, et al. Low cardiac output associated with ventricular tachyarrhythmias in continuous-flow LVAD recipients with a concomitant ICD (LoCo VT Study). J Heart Lung Transplant. 2014;33:318–20.

    Article  Google Scholar 

  25. Kutyifa V, Moss AJ, Schuger C, McNitt S, Polonsky B, Ruwald AH, et al. Reduction in inappropriate ICD therapy in MADIT-RIT patients without history of atrial tachyarrhythmia. J Cardiovasc Electrophysiol. 2015;26:879–84.

    Article  Google Scholar 

  26. Busch MC, Haap M, Kristen A, Haas CS. Asymptomatic sustained ventricular fibrillation in a patient with left ventricular assist device. Ann Emerg Med. 2011;57:25–8.

    Article  Google Scholar 

  27. Fasseas P, Kutalek SP, Kantharia BK. Prolonged sustained ventricular fibrillation without loss of consciousness in patients supported by a left ventricular assist device. Cardiology. 2002;97:210–3.

    Article  Google Scholar 

  28. Oz MC, Rose EA, Slater J, Kuiper JJ, Catanese KA, Levin HR. Malignant ventricular arrhythmias are well tolerated in patients receiving long-term left ventricular assist devices. J Am Coll Cardiol. 1994;24:1688–91.

    Article  CAS  Google Scholar 

  29. Moss AJ, Greenberg H, Case RB, Zareba W, Hall WJ, Brown MW, et al. Long-term clinical course of patients after termination of ventricular tachyarrhythmia by an implanted defibrillator. Circulation. 2004;110:3760–5.

    Article  Google Scholar 

  30. Goldenberg I, Moss AJ, Hall WJ, McNitt S, Zareba W, Andrews ML, et al. Causes and consequences of heart failure after prophylactic implantation of a defibrillator in the multicenter automatic defibrillator implantation trial II. Circulation. 2006;113:2810–7.

    Article  Google Scholar 

  31. Clerkin KJ, Topkara VK, Demmer RT, Dizon JM, Yuzefpolskaya M, Fried JA, et al. Implantable cardioverter-defibrillators in patients with a continuous-flow left ventricular assist device: an analysis of the INTERMACS registry. JACC Heart Fail. 2017;5:916–26.

    Article  Google Scholar 

  32. Richardson TD, Hale L, Arteaga C, Xu M, Keebler M, Schlendorf K, et al. Prospective randomized evaluation of implantable cardioverter-defibrillator programming in patients with a left ventricular assist device. J Am Heart Assoc. 2018;7. https://doi.org/10.1161/JAHA.117.007748.

  33. Wilkoff BL, Fauchier L, Stiles MK, Morillo CA, Al-Khatib SM, Almendral J, et al. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Heart Rhythm. 2016;13:e50–86.

    Article  Google Scholar 

Download references

Acknowledgments

We thank Poojita Shivamurthy, MD (Mount Sinai Hospital, NY), for her initial work in the study.

Author information

Authors and Affiliations

  1. Division of Cardiology, Hartford Hospital, Hartford, CT, USA

    Aswini Kumar, Edmond Cronin, Jason Gluck & Jeffrey Kluger

  2. Department of Medicine, University of Connecticut, Farmington, CT, USA

    Aswini Kumar & Varun Tandon

  3. Department of Research Administration, Hartford HealthCare, Hartford, CT, USA

    David M. O’Sullivan

  4. University of Connecticut School of Medicine, Farmington, CT, USA

    Edmond Cronin, Jason Gluck & Jeffrey Kluger

Authors
  1. Aswini Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Varun Tandon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David M. O’Sullivan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edmond Cronin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jason Gluck
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jeffrey Kluger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aswini Kumar.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Hartford HealthCare Institutional Review Board.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kumar, A., Tandon, V., O’Sullivan, D.M. et al. ICD shocks in LVAD patients are not associated with increased subsequent mortality risk. J Interv Card Electrophysiol 56, 341–348 (2019). https://doi.org/10.1007/s10840-019-00619-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-019-00619-7

Keywords

Search

Navigation