Vincent Galand1, Erwan Flécher2, Vincent Auffret1, Stéphane Boulé3, André Vincentelli3, Camille Dambrin4, Pierre Mondoly4, Frédéric Sacher5, Karine Nubret5, Michel Kindo6, Thomas Cardi6, Philippe Gaudard7, Philippe Rouvière7, Magali Michel8, Jean-Baptiste Gourraud8, Pascal Defaye9, Olivier Chavanon9, Constance Verdonk10, Walid Ghodbane10, Edeline Pelcé11, Vlad Gariboldi11, Matteo Pozzi12, Jean-François Obadia12, Pierre-Yves Litzler13, Frédéric Anselme13, Gerard Babatasi14, Annette Belin14, Fabien Garnier15, Marie Bielefeld15, David Hamon16, Costin Radu16, Bertrand Pierre17, Thierry Bourguignon17, Romain Eschalier18, Nicolas D'Ostrevy18, Marie-Cécile Bories19, Eloi Marijon19, Fabrice Vanhuyse20, Hugues Blangy20, Jean-Philippe Verhoye21, Christophe Leclercq1, Raphaël P Martins22. 1. Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France; Université de Rennes 1, Rennes, France; U1099, INSERM, Rennes, France. 2. Université de Rennes 1, Rennes, France; Service de chirurgie cardiaque et thoracique, Rennes, France. 3. Department of Cardiac Surgery, Department of Cardiology, Cardiac Intensive Care Unit, Institut Coeur-Poumons, CHU Lille, Lille, France. 4. Service de Cardiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France. 5. Service de Cardiologie, Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France. 6. Département de chirurgie cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. 7. Department of Cardiac Surgery, Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France. 8. Department of Cardiology and Heart Transplantation Unit, CHU Nantes, Nantes, France. 9. Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France. 10. Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France. 11. Department of Cardiac Surgery, La Timone Hospital, Marseille, France. 12. Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France. 13. Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France. 14. Department of Cardiology and Cardiac Surgery, University Hospital of Caen, University of Caen, Caen, France. 15. Department of Cardiology and Cardiac Surgery, University Hospital Dijon Bourgogne, Dijon, France. 16. Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France. 17. Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France. 18. Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France. 19. Cardiology Department, European Georges Pompidou Hospital, Paris, France. 20. Department of Cardiology and Cardiac Surgery, Hopital de Brabois, CHU de Nancy, Nancy, France. 21. Service de chirurgie cardiaque et thoracique, Rennes, France. 22. Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France; Université de Rennes 1, Rennes, France; U1099, INSERM, Rennes, France. Electronic address: raphael.martins@chu-rennes.fr.
Abstract
OBJECTIVES: This study aimed to evaluate the incidence, clinical impact, and predictors of late ventricular arrhythmias (VAs) in left ventricular assist device (LVAD) recipients aiming to clarify implantable cardioverter-defibrillator (ICD) indications. BACKGROUND: The arrhythmic risk and need for ICD in patients implanted with an LVAD are not very well known. METHODS: This observational study was conducted in 19 centers between 2006 and 2016. Late VAs were defined as sustained ventricular tachycardia or fibrillation occurring >30 days post-LVAD implantation, without acute reversible cause and requiring appropriate ICD therapy, external electrical shock, or medical therapy. RESULTS: Among 659 LVAD recipients, 494 (median 58.9 years of age; mean left ventricular ejection fraction 20.7 ± 7.4%; 73.1% HeartMate II, 18.6% HeartWare, 8.3% Jarvik 2000) were discharged alive from hospital and included in the final analysis. Late VAs occurred in 133 (26.9%) patients. Multivariable analysis identified 6 independent predictors of late VAs: VAs before LVAD implantation, atrial fibrillation before LVAD implantation, idiopathic etiology of the cardiomyopathy, heart failure duration >12 months, early VAs (<30 days post-LVAD), and no angiotensin-converting enzyme inhibitors during follow-up. The "VT-LVAD score" was created, identifying 4 risk groups: low (score 0 to 1), intermediate (score 2 to 4), high (score 5 to 6), and very high (score 7 to 10). The rates of VAs at 1 year were 0.0%, 8.0%, 31.0% and 55.0%, respectively. CONCLUSIONS: Late VAs are common after LVAD implantation. The VT-LVAD score may help to identify patients at risk of late VAs and guide ICD indications in previously nonimplanted patients. (Determination of Risk Factors of Ventricular Arrhythmias [VAs] after implantation of continuous flow left ventricular assist device with continuous flow left ventricular assist device [CF-LVAD] [ASSIST-ICD]; NCT02873169).
OBJECTIVES: This study aimed to evaluate the incidence, clinical impact, and predictors of late ventricular arrhythmias (VAs) in left ventricular assist device (LVAD) recipients aiming to clarify implantable cardioverter-defibrillator (ICD) indications. BACKGROUND: The arrhythmic risk and need for ICD in patients implanted with an LVAD are not very well known. METHODS: This observational study was conducted in 19 centers between 2006 and 2016. Late VAs were defined as sustained ventricular tachycardia or fibrillation occurring >30 days post-LVAD implantation, without acute reversible cause and requiring appropriate ICD therapy, external electrical shock, or medical therapy. RESULTS: Among 659 LVAD recipients, 494 (median 58.9 years of age; mean left ventricular ejection fraction 20.7 ± 7.4%; 73.1% HeartMate II, 18.6% HeartWare, 8.3% Jarvik 2000) were discharged alive from hospital and included in the final analysis. Late VAs occurred in 133 (26.9%) patients. Multivariable analysis identified 6 independent predictors of late VAs: VAs before LVAD implantation, atrial fibrillation before LVAD implantation, idiopathic etiology of the cardiomyopathy, heart failure duration >12 months, early VAs (<30 days post-LVAD), and no angiotensin-converting enzyme inhibitors during follow-up. The "VT-LVAD score" was created, identifying 4 risk groups: low (score 0 to 1), intermediate (score 2 to 4), high (score 5 to 6), and very high (score 7 to 10). The rates of VAs at 1 year were 0.0%, 8.0%, 31.0% and 55.0%, respectively. CONCLUSIONS: Late VAs are common after LVAD implantation. The VT-LVAD score may help to identify patients at risk of late VAs and guide ICD indications in previously nonimplanted patients. (Determination of Risk Factors of Ventricular Arrhythmias [VAs] after implantation of continuous flow left ventricular assist device with continuous flow left ventricular assist device [CF-LVAD] [ASSIST-ICD]; NCT02873169).
Authors: Annemijn Vis; Maziar Arfaee; Husain Khambati; Mark S Slaughter; Jan F Gummert; Johannes T B Overvelde; Jolanda Kluin Journal: Nat Rev Cardiol Date: 2022-06-06 Impact factor: 32.419
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