Ventricular Arrhythmias and Implantable Cardioverter-Defibrillator Therapy in Patients With Continuous-Flow Left Ventricular Assist Devices: Need for Primary Prevention?

Jun 17, 2013
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Authors:
Garan AR, Yuzefpolskaya M, Colombo PC, et al.
Citation:
J Am Coll Cardiol 2013;61:2542-2550.
Summary By:
Reema Hasan, MD

Study Questions:

Is implantable cardioverter-defibrillator (ICD) therapy necessary in patients receiving a long-term continuous-flow left ventricular assist device (CF-LVAD), and what is the prevalence and significance of ventricular arrhythmia (VA) in this patient population?

Methods:

This was a single-center, prospective study, which enrolled all patients with a long-term CF-LVAD from January 1, 2012 to October 1, 2012. ICDs were interrogated at baseline through follow-up. The primary outcome was the occurrence of VAs (>30 days postoperatively) after LVAD implantation. The VA was defined as ventricular tachycardia or ventricular fibrillation lasting >30 seconds or terminated by appropriate ICD tachytherapy.

Results:

Ninety-four patients were enrolled; 77 had an ICD and 17 did not. The average age was 62.2 ± 12.0 years, and 85.1% were men; 52.1% had an ischemic cardiomyopathy, and 52.1% were implanted as bridge to transplantation. A VA event occurred in 20.2% of patients <30 days postimplantation, and a VA event occurred in 23.4% of patients >30 days postimplantation. Preimplantation VA was an independent predictor of postoperative VA (45.5% vs. 4%; p < 0.001). There were no deaths among patients discharged after LVAD implantation without an ICD during follow-up.

Conclusions:

Although patients without preoperative VA events are at low risk, patients with preoperative VA are at risk for postoperative VA events, and should have active ICD therapy.

Perspective:

In this patient population studied, CF-LVADs appear to provide enough support to prevent sudden arrhythmic death in patients without an ICD. The need for ICD therapy in patients with CF-LVADs and no preoperative VA events remains to be questioned, and should be studied further in larger multicenter trials.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, SCD/Ventricular Arrhythmias, Acute Heart Failure

Keywords: Heart Failure, Defibrillators, Implantable


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