title: Risk of mortality for ventricular arrhythmia in ambulatory LVAD patients.
abstract: BACKGROUND
  There are limited data regarding the incidence and prognostic significance of ventricular arrhythmias (VA) in ambulatory continuous flow left ventricular assist device (LVAD) patients.
  
  
  METHODS
  Sixty-one consecutive patients from November 1, 2006 through December 31, 2010 with an LVAD and implantable cardioverter defibrillator that survived to discharge from the LVAD implantation admission were studied. Follow-up began from date of discharge with both devices in situ and ended with death, transplant, on June 1, 2011. Pre-LVAD VA history was related to the primary endpoints of post-LVAD VA, mortality, and the combined endpoint of post-LVAD VA/mortality.
  
  
  RESULTS
  During a mean follow-up of 622 days 19 patients (31%) experienced VA (14 episodes of VT, 5 episodes of VF). Pre-LVAD VA was predictive of post-LVAD VA (hazard ratio [HR] 2.91, P = 0.026) and the combined post-LVAD VA/mortality endpoint (HR 2.70, P = 0.021) but only displayed a nonsignificant association with mortality (HR 2.30, P = 0.11). In multivariate analysis, pre-LVAD VA remained a significant predictor of post-LVAD VA (HR 2.84, P = 0.03) and the combined post-LVAD VA/mortality endpoint (HR 2.65, P = 0.025). Post-LVAD VA was the strongest univariate predictor of mortality (HR 13.92, P < 0.001) and remained so after multivariate adjustment (HR 9.69, P = 0.001). Post-LVAD VA occurred at a mean of 1 year from mortality events with 45% within 1 month.
  
  
  CONCLUSIONS
  Pre-LVAD VA is a significant predictor of post-LVAD VA but not of mortality. VA in the continuous flow LVAD population carries a significant risk of mortality often within the first month.
authors.affiliation: Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA. Andrew_brenyo@urmc.rochester.edu
authors.forename: Andrew
authors.initials: A
authors.lastname: Brenyo
authors.forename: Mohan
authors.initials: M
authors.lastname: Rao
authors.forename: Sushma
authors.initials: S
authors.lastname: Koneru
authors.forename: William
authors.initials: W
authors.lastname: Hallinan
authors.forename: Samit
authors.initials: S
authors.lastname: Shah
authors.forename: H T
authors.initials: HT
authors.lastname: Massey
authors.forename: Leway
authors.initials: L
authors.lastname: Chen
authors.forename: Bronislava
authors.initials: B
authors.lastname: Polonsky
authors.forename: Scott
authors.initials: S
authors.lastname: McNitt
authors.forename: David T
authors.initials: DT
authors.lastname: Huang
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.forename: Mehmet
authors.initials: M
authors.lastname: Aktas
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D016009:Chi-Square Distribution; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000009:adverse effects; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left