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

Journal of Interventional Cardiac Electrophysiology volume 56, pages 341–348 (2019)Cite this article

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.

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Fig. 1

Abbreviations

LVAD:

Left ventricular assist device

VA:

Ventricular arrhythmia

DT:

Destination therapy

BTT:

Bridge to transplant

BTD:

Bridge to decision

ATP:

Anti-tachycardia pacing

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Acknowledgments

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

Author information

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
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  2. Varun Tandon
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  3. David M. O’Sullivan
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  4. Edmond Cronin
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  5. Jason Gluck
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  6. Jeffrey Kluger
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Corresponding author

Correspondence to Aswini Kumar.

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The authors declare that they have no conflict of interest.

Ethical approval

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

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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

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

Keywords

  • LVAD
  • Ventricular arrhythmia
  • ICD shocks
  • Mortality
  • Symptoms