title: Ventricular arrhythmias and implantable cardioverter-defibrillator therapy in patients with continuous-flow left ventricular assist devices: need for primary prevention?
abstract: OBJECTIVE
  This study sought to evaluate the prevalence and significance of ventricular arrhythmia (VA) and the role of an implantable cardioverter-defibrillator (ICD) in patients supported by a continuous-flow left ventricular assist device (CF-LVAD).
  
  
  BACKGROUND
  VAs are common in patients supported by CF-LVADs but prospective data to support the routine use of ICDs in these patients are lacking.
  
  
  METHODS
  All patients supported by long-term CF-LVAD receiving care at our institution were enrolled. The ICDs were interrogated at baseline and throughout prospective follow-up. The VA was defined as ventricular tachycardia/fibrillation lasting >30 s or effectively terminated by appropriate ICD tachytherapy. The primary outcome was the occurrence of VA >30 days after CF-LVAD implantation.
  
  
  RESULTS
  Ninety-four patients were enrolled; 77 had an ICD and 17 did not. Five patients with an ICD had it deactivated or a depleted battery not replaced during the study. Twenty-two patients had a VA >30 days after LVAD implantation. Pre-operative VA was the major predictor of post-operative arrhythmia. Absence of pre-operative VA conferred a low risk of post-operative VA (4.0% vs. 45.5%; p < 0.001). No patients discharged from the hospital without an ICD after CF-LVAD implantation died during 276.2 months of follow-up (mean time without ICD, 12.7 ± 12.3 months).
  
  
  CONCLUSIONS
  Patients with pre-operative VA are at risk of recurrent VA while on CF-LVAD support and should have active ICD therapy to minimize sustained VA. Patients without pre-operative VA are at low risk and may not need active ICD therapy.
authors: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York 10032, USA.
authors: Arthur R
authors: AR
authors: Garan
authors: Melana
authors: M
authors: Yuzefpolskaya
authors: Paolo C
authors: PC
authors: Colombo
authors: John P
authors: JP
authors: Morrow
authors: Rosie
authors: R
authors: Te-Frey
authors: Drew
authors: D
authors: Dano
authors: Hiroo
authors: H
authors: Takayama
authors: Yoshifumi
authors: Y
authors: Naka
authors: Hasan
authors: H
authors: Garan
authors: Ulrich P
authors: UP
authors: Jorde
authors: Nir
authors: N
authors: Uriel
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices / Q000009:adverse effects / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000379:methods / Q000639:trends*; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014693:Ventricular Fibrillation / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*