title: Incidence, risk, and consequences of atrial arrhythmias in patients with continuous-flow left ventricular assist devices.
abstract: BACKGROUND
  Although atrial arrhythmias (AAs) are common in heart failure, the incidence of AAs subsequent to the placement of left ventricular assist devices (LVADs) has not been elucidated.
  
  
  METHODS
  Patients receiving a HeartMate II LVAD in the bridge to transplant (n = 490) and destination therapy (n = 634) trials were included (n = 1125). AAs requiring treatment were recorded, regardless of symptoms. Using Cox models with and without a 60-day blanking period, risk factors for early and late AAs were determined.
  
  
  RESULTS
  In total, there were 271 AAs in 231 patients (21%), most of which occurred within the first 60 days. Patients with and without AAs had similar survival (p = 0.16). Serum creatinine (hazard ratio [HR] = 1.49 per unit increase, 1.18 to 1.88; p < 0.001) and ejection fraction (HR = 0.98 per 1% increase, 0.95 to 0.999; p = 0.04) were associated with AAs in a multivariable model. Although quality of life (QoL) and functional status improved in all patients, those with AAs had worse unadjusted QoL (p < 0.001) and a decreased rate of improvement in six-minute walk distance over six to 24 months postimplant (p = 0.016).
  
  
  CONCLUSIONS
  Approximately one-fifth of LVAD patients have AAs, most commonly within the first 60 days of support. Preoperative creatinine is a strong risk factor for early and late AAs. Although AAs do not impact survival, they are associated with decreased functional status and QoL improvements during LVAD support.
authors.affiliation: Department of Medicine, Cardiovascular Division, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Brisco
authors.forename: Kartik S
authors.initials: KS
authors.lastname: Sundareswaran
authors.forename: Carmelo A
authors.initials: CA
authors.lastname: Milano
authors.forename: David
authors.initials: D
authors.lastname: Feldman
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Testani
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Ewald
authors.forename: Mark S
authors.initials: MS
authors.lastname: Slaughter
authors.forename: David J
authors.initials: DJ
authors.lastname: Farrar
authors.forename: Lee R
authors.initials: LR
authors.lastname: Goldberg
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D003404:Creatinine / Q000097:blood; D005260:Female; D006325:Heart Atria; D006333:Heart Failure / Q000097:blood / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057234:Preoperative Period; D016016:Proportional Hazards Models; D011788:Quality of Life; D012306:Risk; D012307:Risk Factors; D013997:Time Factors
chemical_list: D003404:Creatinine