Raphaël P Martins1, Christophe Leclercq2, Hamed Bourenane2, Vincent Auffret2, Stéphane Boulé3, Valentin Loobuyck3, Camille Dambrin4, Pierre Mondoly4, Frédéric Sacher5, Pierre Bordachar5, Michel Kindo6, Thomas Cardi6, Philippe Gaudard7, Philippe Rouvière7, Magali Michel8, Jean-Baptiste Gourraud8, Pascal Defaye9, Olivier Chavanon9, Caroline Kerneis10, Walid Ghodhbane10, Edeline Pelcé11, Vlad Gariboldi11, Matteo Pozzi12, Daniel Grinberg12, Pierre-Yves Litzler13, Frédéric Anselme13, Gerard Babatasi14, Annette Belin14, Fabien Garnier15, Marie Bielefeld15, David Hamon16, Nicolas Lellouche16, Bertrand Pierre17, Thierry Bourguignon17, Romain Eschallier18, Nicolas D'Ostrevy18, Marie-Cécile Bories19, Jérôme Jouan19, Fabrice Vanhuyse20, Nicolas Sadoul20, Erwan Flécher2, Vincent Galand2. 1. Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France. Electronic address: raphael.martins@chu-rennes.fr. 2. Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France. 3. Department of Cardiology, CHU Lille, Institut Coeur-Poumons, Lille, France. 4. Department of Cardiology, CHU de Toulouse, Toulouse, France. 5. Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux, 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, University of Caen and University Hospital of Caen, Caen, France. 15. Department of Cardiology and Cardiac Surgery, University Hospital, 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. Department of Cardiology, CHU Clermont-Ferrand, Clermont-Ferrand, France. 19. Department of Cardiology, European Georges Pompidou Hospital, Paris, France. 20. Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France.
Abstract
BACKGROUND: Ventricular arrhythmias (VAs) can occur after continuous flow left ventricular assist device (LVAD) implantation as a single arrhythmic event or as electrical storm (ES) with multiple repetitive VA episodes. OBJECTIVE: We aimed at analyzing the incidence, predictors, and clinical impact of ES in LVAD recipients. METHODS: Patients analyzed were those included in the multicenter ASSIST-ICD observational study. ES was consensually defined as occurrence of ≥3 separate episodes of sustained VAs within a 24-hour interval. RESULTS: Of 652 patients with an LVAD, 61 (9%) presented ES during a median follow-up period of 9.1 (interquartile range [IQR] 2.5-22.1) months. The first ES occurred after 17 (IQR 4.0-56.2) days post LVAD implantation, most of them during the first month after the device implantation (63%). The incidence then tended to decrease during the initial years of follow-up and increased again after the third year post LVAD implantation. History of VAs before LVAD implantation and heart failure duration > 84 months were independent predictors of ES. The occurrence of ES was associated with an increased early mortality since 20 patients (33%) died within the first 2 weeks of ES. Twenty-two patients (36.1%) presented at least 1 recurrence of ES, occurring 43.0 (IQR 8.0-69.0) days after the initial ES. Patients experiencing ES had a significantly lower 1-year survival rate than did those free from ES (log-rank, P = .039). CONCLUSION: There is a significant incidence of ES in patients with an LVAD. The short-term mortality after ES is high, and one-third of patients will die within 15 days. Whether radiofrequency ablation of arrhythmias improves outcomes would require further studies.
BACKGROUND:Ventricular arrhythmias (VAs) can occur after continuous flow left ventricular assist device (LVAD) implantation as a single arrhythmic event or as electrical storm (ES) with multiple repetitive VA episodes. OBJECTIVE: We aimed at analyzing the incidence, predictors, and clinical impact of ES in LVAD recipients. METHODS:Patients analyzed were those included in the multicenter ASSIST-ICD observational study. ES was consensually defined as occurrence of ≥3 separate episodes of sustained VAs within a 24-hour interval. RESULTS: Of 652 patients with an LVAD, 61 (9%) presented ES during a median follow-up period of 9.1 (interquartile range [IQR] 2.5-22.1) months. The first ES occurred after 17 (IQR 4.0-56.2) days post LVAD implantation, most of them during the first month after the device implantation (63%). The incidence then tended to decrease during the initial years of follow-up and increased again after the third year post LVAD implantation. History of VAs before LVAD implantation and heart failure duration > 84 months were independent predictors of ES. The occurrence of ES was associated with an increased early mortality since 20 patients (33%) died within the first 2 weeks of ES. Twenty-two patients (36.1%) presented at least 1 recurrence of ES, occurring 43.0 (IQR 8.0-69.0) days after the initial ES. Patients experiencing ES had a significantly lower 1-year survival rate than did those free from ES (log-rank, P = .039). CONCLUSION: There is a significant incidence of ES in patients with an LVAD. The short-term mortality after ES is high, and one-third of patients will die within 15 days. Whether radiofrequency ablation of arrhythmias improves outcomes would require further studies.