Arthur R Garan1, Allison P Levin2, Veli Topkara2, Sunu S Thomas3, Melana Yuzefpolskaya2, Paolo C Colombo2, Koji Takeda4, Hiroo Takayama4, Yoshifumi Naka4, William Whang2, Ulrich P Jorde5, Nir Uriel6. 1. Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York. Electronic address: arg2024@cumc.columbia.edu. 2. Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York. 3. Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 4. Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York. 5. Department of Medicine, Division of Cardiology, Montefiore Medical Center, New York, New York. 6. Department of Medicine, Division of Cardiology, University of Chicago Medical Center, Chicago, Illinois.
Abstract
BACKGROUND: Ventricular arrhythmias (VAs) are common in patients with a continuous-flow left ventricular assist device (CF-LVAD). The causes and clinical significance of early post-operative VAs have not previously been characterized in these patients. The purpose of this study was to assess the incidence, precipitants, and clinical impact of early VAs in patients supported by CF-LVADs. METHODS: Patients with a long-term CF-LVAD receiving care between January 1, 2012, and March 1, 2014, were enrolled and followed prospectively. Implantable cardioverter-defibrillators (ICDs) were interrogated at baseline and throughout the follow-up period. VA was defined as ventricular tachycardia or ventricular fibrillation lasting >30 seconds or effectively terminated by appropriate ICD tachytherapy or external defibrillation. The primary end-point was the occurrence of early VAs (within 30 days of surgery). Secondary end-points were right ventricular (RV) failure and need for VA ablation. RESULTS: There were 162 patients enrolled, and 38 (23.5%) experienced at least 1 early VA. Predictors of early VA were a history of pre-operative VAs, non-ischemic cardiomyopathy, and older age. Several conditions frequently encountered in the early post-operative period were identified as possible precipitants for VA episodes. Early VAs were associated with post-operative RV failure, particularly when patients received shocks instead of anti-tachycardia pacing. CONCLUSIONS: Early VAs are common and are associated with RV failure. ICD shocks, but not anti-tachycardia pacing, for early VAs are associated with acute worsening of RV failure.
BACKGROUND:Ventricular arrhythmias (VAs) are common in patients with a continuous-flow left ventricular assist device (CF-LVAD). The causes and clinical significance of early post-operative VAs have not previously been characterized in these patients. The purpose of this study was to assess the incidence, precipitants, and clinical impact of early VAs in patients supported by CF-LVADs. METHODS:Patients with a long-term CF-LVAD receiving care between January 1, 2012, and March 1, 2014, were enrolled and followed prospectively. Implantable cardioverter-defibrillators (ICDs) were interrogated at baseline and throughout the follow-up period. VA was defined as ventricular tachycardia or ventricular fibrillation lasting >30 seconds or effectively terminated by appropriate ICD tachytherapy or external defibrillation. The primary end-point was the occurrence of early VAs (within 30 days of surgery). Secondary end-points were right ventricular (RV) failure and need for VA ablation. RESULTS: There were 162 patients enrolled, and 38 (23.5%) experienced at least 1 early VA. Predictors of early VA were a history of pre-operative VAs, non-ischemic cardiomyopathy, and older age. Several conditions frequently encountered in the early post-operative period were identified as possible precipitants for VA episodes. Early VAs were associated with post-operative RV failure, particularly when patients received shocks instead of anti-tachycardia pacing. CONCLUSIONS: Early VAs are common and are associated with RV failure. ICD shocks, but not anti-tachycardia pacing, for early VAs are associated with acute worsening of RV failure.
Authors: Kevin J Clerkin; Veli K Topkara; Donna M Mancini; Melana Yuzefpolskaya; Ryan T Demmer; Jose M Dizon; Koji Takeda; Hiroo Takayama; Yoshifumi Naka; Paolo C Colombo; A Reshad Garan Journal: J Heart Lung Transplant Date: 2016-12-01 Impact factor: 10.247
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Saenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: J Interv Card Electrophysiol Date: 2020-10 Impact factor: 1.900
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Sáenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: Europace Date: 2019-08-01 Impact factor: 5.214
Authors: Lauren B Cooper; Robert J Mentz; Leah B Edwards; Amber R Wilk; Joseph G Rogers; Chetan B Patel; Carmelo A Milano; Adrian F Hernandez; Josef Stehlik; Lars H Lund Journal: J Heart Lung Transplant Date: 2016-07-17 Impact factor: 10.247
Authors: David M Tehrani; Sirtaz Adatya; Jonathan Grinstein; Daniel Rodgers; Nitasha Sarswat; Gene H Kim; Jayant Raikhelkar; Gabriel Sayer; Nir Uriel Journal: ASAIO J Date: 2019-02 Impact factor: 2.872
Authors: Kevin J Clerkin; Veli K Topkara; Ryan T Demmer; Jose M Dizon; Melana Yuzefpolskaya; Justin A Fried; Xingchen Mai; Donna M Mancini; Koji Takeda; Hiroo Takayama; Yoshifumi Naka; Paolo C Colombo; A Reshad Garan Journal: JACC Heart Fail Date: 2017-12 Impact factor: 12.035
Authors: Andrew Y Lin; Hao Tran; Michela Brambatti; Eric Adler; Victor Pretorius; Travis Pollema; Jonathan C Hsu; Gregory K Feld; Kurt Hoffmayer; Frederick Han; David Krummen; Gordon Ho Journal: J Interv Card Electrophysiol Date: 2019-12-14 Impact factor: 1.900