Arrhythmias common after LVAD implantation; did not increase mortality risk
LAS VEGAS — Implantation with a left ventricular assist device increased the risk for arrhythmia development, but the presence of arrhythmias did not increase mortality risk in a study presented at the Heart Failure Society of America Annual Scientific Meeting.
Researchers performed a post-hoc analysis of 382 patients enrolled in the ADVANCE Bridge-to-Transplant clinical trial, all of whom were implanted with a HeartWare (HeartWare Inc.) ventricular assist device (HVAD). Patients had advanced HF in 140 cases and received HVAD as a bridge to cardiac transplantation, and 87% of the population had an ICD implanted at the time of implantation. The cohort had a mean age of 53 years, was 71.2% male and had HF with ischemic etiology in 38% of cases. The mean time on support across the cohort was 389 days (range 1-1,506 days).
Arrhythmias occurred in 36% of patients during follow-up, with 205 events during 406.6 patient-years. Arrhythmias were ventricular in 49% of cases, supraventricular in 47% and both in 2%. The researchers noted that 52% of arrhythmias occurred within 30 days of implantation with an HVAD.
Patients who developed arrhythmias had associated clinical symptoms in 75% of cases. Most arrhythmias (73%) were managed medically, whereas 21% of patients required cardioversion.
Seventy-five percent of those with arrhythmias had associated clinical symptoms.
Patients who developed arrhythmias experienced other adverse events significantly more frequently than those who did not, including infection (65.7% vs. 51.4%; P=.0073), particularly infection not related to the device (41.6% vs. 25.7%; P=.0019); respiratory dysfunction within 30 days (31.4% vs. 18.4%; P=.0052); device malfunction/failure (27.7% vs. 18.4%; P=.0386); early venous thromboembolism (13.9% vs. 6.9%; P=.0296); and hepatic dysfunction (8.8% vs. 3.3%; P=.0295). However, incidence rates for ischemic stroke, hemorrhagic stroke and transient ischemic attack were similar between patients with and without arrhythmias.
The researchers also noted that mortality rates were similar regardless of arrhythmia development: Survival rates at 2 years were 72.3% among those with one or more arrhythmia episodes and 72.9% among those with no arrhythmias (P=.7). The presence of an implantable cardioverter defibrillator did not significantly affect survival among those who developed arrhythmias.
“Arrhythmias were very common post HeartWare LVAD implant,” Salpy V. Pamboukian, MD, of the University of Alabama at Birmingham, concluded during a presentation here. “Most arrhythmias were associated with clinical symptoms, such as hypotension and decreased VAD flows, and the majority were managed medically. Despite some increases in morbidity, arrhythmias were not associated with increased mortality in patients with a HeartWare LVAD.”
For more information:
Pamboukian SV. Abstract #019. Rapid-Fire Abstracts I. Presented at: the Heart Failure Society of American Annual Scientific Meeting; Sept. 14-17, 2014; Las Vegas.
Disclosure: The researchers report no relevant financial disclosures.