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Atrial Tachyarrhythmias in LVAD Patients
Study Questions:
What is the burden of atrial fibrillation (AF) and atrial flutter (AFL) in patients with left ventricular assist devices (LVADs), and what is the impact of rhythm control strategies?
Methods:
This was a retrospective analysis of all LVAD recipients at the Cleveland Clinic examining the association of death, thromboembolism, and major bleeding with AF/AFL and exposure to rhythm control measures.
Results:
A total of 418 patients (median age 58 years, 80% male) were followed for a median of 445 days. The prevalence of AF was 69% and AFL was 15%. Patients with AF/AFL (72%) and without AF/AFL (28%) had similar mortality (39% vs. 38%; p = NS) and major bleeding (46% vs. 49%; p = NS). AF/AFL patients had fewer thromboembolic events (13% vs. 23%; p < 0.01). Rhythm control exposure did not affect mortality (39% vs. 43%; p = NS), thromboembolism (13% vs. 17%; p = NS), or bleeding (49% vs. 39%; p = NS). In the multivariable survival analysis, AF/AFL had no association with risk of death, thromboembolism, or bleeding.
Conclusions:
AF/AFL is prevalent among LVAD patients, but is not associated with increased mortality, thromboembolism, or bleeding.
Perspective:
Prior studies on the impact of AF/AFL on outcomes in LVAD patients had mixed results. In this study, advanced heart failure and complications associated with LVAD diluted any impact AF/AFL had on outcomes. The completely unexpected finding of fewer strokes in the AF/AFL cohort may perhaps be due to the fact that AF/AFL patients were more likely to be discharged with an antiplatelet drug plus an anticoagulant (91% vs. 79%). The International Society for Heart and Lung Transplantation Guidelines do recommend both warfarin and aspirin in LVAD patients.
Keywords: Anticoagulants, Arrhythmias, Cardiac, Aspirin, Atrial Fibrillation, Atrial Flutter, Heart-Assist Devices, Heart Failure, Hemorrhage, Platelet Aggregation Inhibitors, Stroke, Tachycardia, Thromboembolism, Warfarin
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