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Ventricular arrhythmias in patients with biventricular assist devices

Journal of Interventional Cardiac Electrophysiology volume 58, pages 243–252 (2020)Cite this article

Abstract

Purpose

Ventricular arrhythmias (VAs) are common in patients after left ventricular assist device (LVAD) implant and are associated with worse outcomes. However, the prevalence and impact of VA in patients with durable biventricular assist device (BIVAD) is unknown. We performed a retrospective cohort study of patients with BIVADs to evaluate the prevalence of VA and their clinical outcomes.

Methods

Consecutive patients who received a BIVAD between June 2014 and July 2017 at our medical center were included. The prevalence of VA, defined as sustained ventricular tachycardia or fibrillation requiring defibrillation or ICD therapy, was compared between BIVAD patients and a propensity-matched population of patients with LVAD from our center. The occurrence of adverse clinical events was compared between BIVAD patients with and without VA.

Results

Of the 13 patients with BIVADs, 6 patients (46%) experienced clinically significant VA, similar to a propensity-matched LVAD population (38%, p = 1.00). There were no differences in baseline characteristics between the two cohorts, except patients in the non-VA group who had worse hemodynamics (mitral regurgitation and right-sided indices), had less history of VA, and were younger. BIVAD patients with VA had a higher incidence of major bleeding (MR 3.05 (1.07–8.66), p = 0.036) and worse composite outcomes (log-rank test, p = 0.046). The presence of VA was associated with worse outcomes in both LVAD and BIVAD groups.

Conclusions

Ventricular arrhythmias are common in patients with BIVADs and are associated with worse outcomes. Future work should assess whether therapies such as ablation improve the outcome of BIVAD patients with VA.

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Abbreviations

AF:

Atrial fibrillation

ATP:

Anti-tachycardia pacing

BIVAD:

Biventricular assist device

CVA:

Cerebrovascular accident

EF:

Ejection fraction

EPPY:

Events per patient year

GFR:

Glomerular filtration rate

GI:

Gastrointestinal

HF:

Heart failure

IABP:

Intra-aortic balloon pump

ICD:

Implanted cardioverter-defibrillator

INTERMACS:

Interagency Registry for Mechanically Assisted Circulatory Support

LA:

Left atrium

LVAD:

Left ventricular assist device

LV-HVAD:

Left ventricular HeartWare ventricular assist device

RA-HVAD:

Right atrial HeartWare ventricular assist device

LVIDd:

Left ventricle internal diameter diastole

PAPI:

Pulmonary artery pulsatility index

PASP:

Pulmonary artery systolic pressure

PCWP:

Pulmonary capillary wedge pressure

PVR:

Pulmonary vascular resistance

RAP:

Right atrial pressure

RV:

Right ventricle

RVSP:

Right ventricular systolic pressure

RVSWI:

Right ventricular stroke work index

RVAD:

Right ventricular assist device

TAPSE:

Tricuspid annular plane systolic excursion

VA:

Ventricular arrhythmia

VT:

Ventricular tachycardia

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Funding

This work was partially supported by a research grant from the American Heart Association (19CDA34760021).

Author information

Affiliations

  1. Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, 9452 Medical Center Dr. MC 7411, La Jolla, CA, 92037, USA

    Andrew Y. Lin, Hao Tran, Michela Brambatti, Eric Adler, Jonathan C. Hsu, Gregory K. Feld, Kurt Hoffmayer, Frederick Han, David Krummen & Gordon Ho

  2. Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Institute, University of California San Diego, 9452 Medical Center Dr., La Jolla, CA, 92037, USA

    Victor Pretorius & Travis Pollema

Authors
  1. Andrew Y. Lin
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  2. Hao Tran
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  3. Michela Brambatti
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  4. Eric Adler
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  5. Victor Pretorius
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  6. Travis Pollema
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  7. Jonathan C. Hsu
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  8. Gregory K. Feld
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  9. Kurt Hoffmayer
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  10. Frederick Han
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  11. David Krummen
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  12. Gordon Ho
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Corresponding author

Correspondence to Gordon Ho.

Ethics declarations

The study protocol was approved by the institutional review board at University of California San Diego and adhered to the principles of the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

Drs. Lin, Tran, Brambatti, Pretorius, Pollema, Hoffmayer, and Han have no disclosures. Dr. Adler is a consultant for Medtronic and Abbott. Dr. Feld is Director of the Cardiac Electrophysiology Fellowship Training Program whom receives fellowship stipend support from Medtronic, Abbott, Boston Scientific, Biosense Webster, and Biotronik. Dr. Krummen reports fellowship support from Medtronic, Boston Scientific, Abbott, and Biotronik. Dr. Ho has received research grants from the National Institutes of Health (1KL2TR001444) and the American Heart Association (19CDA34760021) for work related to this project, grant support from Abbott for work unrelated to this project, fellowship support from Medtronic, Boston Scientific, Abbott, and Biotronik, and has equity in Vektor Medical Inc. which is unrelated to this project.

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Lin, A.Y., Tran, H., Brambatti, M. et al. Ventricular arrhythmias in patients with biventricular assist devices. J Interv Card Electrophysiol 58, 243–252 (2020). https://doi.org/10.1007/s10840-019-00682-0

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Keywords

  • Ventricular arrhythmia
  • Ventricular tachycardia
  • Biventricular assist device
  • Heart failure