title: Epidemiology, management, and outcomes of sustained ventricular arrhythmias after continuous-flow left ventricular assist device implantation.
abstract: BACKGROUND
  Left ventricular assist devices (LVADs) are pivotal treatment options for patients with end-stage heart failure. Despite robust left ventricular unloading, the right ventricle remains unsupported and susceptible to hemodynamic perturbations from ventricular arrhythmias (VAs). Little is known about the epidemiology, management, resource use, and outcomes of sustained VAs in continuous-flow LVAD patients.
  
  
  METHODS
  We reviewed data from all consecutive patients receiving a continuous-flow LVAD at the University of North Carolina from January 2006 to February 2011. Patient demographics, pharmacotherapies, resource use, and outcomes were recorded. Descriptive statistics were generated, and multivariable logistic regression was used to assess the independent association of clinical variables on the development of postimplantation VAs.
  
  
  RESULTS
  Of 61 patients, 26 (43%) had sustained VAs after LVAD. Most were male (65%), had history of hypertension (65%), and had nonischemic cardiomyopathy (62%). Patients with VAs after LVAD more often had preimplant VAs (62% vs 14%, P < .01), prior implantable cardioverter-defibrillator (92% vs 71%, P = .04), and history of implantable cardioverter-defibrillator discharge (38% vs 11%, P < .01). Although length of stay was similar, those with postimplant VAs had greater rehospitalization rates, greater antiarrhythmic drug use, and frequently required external defibrillation. Using multivariable logistic regression, only history of prior VA was associated with postimplant arrhythmias (odds ratio 13.7, P < .001).
  
  
  CONCLUSIONS
  Ventricular arrhythmias in LVAD patients are common, often refractory to conservative therapy, and associated with frequent rehospitalization. Post-LVAD VAs, however, did not significantly impact survival or transplantation rates. Arrhythmia burden should be considered before LVAD placement, and future study should focus on the impact of VAs on quality of life.
authors.affiliation: University of North Carolina Center for Heart and Vascular Care, Division of Cardiology, Chapel Hill, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Raasch
authors.forename: Brian C
authors.initials: BC
authors.lastname: Jensen
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Chang
authors.forename: John P
authors.initials: JP
authors.lastname: Mounsey
authors.forename: Anil K
authors.initials: AK
authors.lastname: Gehi
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Chung
authors.forename: Brett C
authors.initials: BC
authors.lastname: Sheridan
authors.forename: Amanda
authors.initials: A
authors.lastname: Bowen
authors.forename: Jason N
authors.initials: JN
authors.lastname: Katz
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy*; D006352:Heart Ventricles; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents