Ventricular Arrhythmias and Implantable Cardioverter-Defibrillator Therapy in Patients With Continuous-Flow Left Ventricular Assist Devices: Need for Primary Prevention?
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?
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.
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.
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.
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.
Keywords: Heart Failure, Defibrillators, Implantable
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