title: Meta-Analysis of the Relation of Ventricular Arrhythmias to All-Cause Mortality After Implantation of a Left Ventricular Assist Device.
abstract: Ventricular arrhythmias (VAs) are commonly reported after implantation of left ventricular assist devices (LVADs). Their relation to all-cause mortality and potential risk factors remains unclear. We conducted a meta-analysis of observational studies with the primary objective of evaluating the association of post-LVAD VAs with all-cause mortality at 60, 120, and 180 days. The secondary end point was the association of potential risk factors (cause of cardiomyopathy, indication for LVAD, and history of VA) with mortality in patients with post-LVAD VAs. We searched MEDLINE, Embase, and Cochrane Central from 2001 to 2015. Two reviewers independently searched, selected, and assessed quality of included studies with differences resolved by consensus. Data were collected and analyzed using random- and fixed-effect model, as appropriate, with inverse-variance weighting. Of 2,393 studies identified, 9 observational studies were eligible including 1,179 patients with a mean follow-up of 220 days. Post-LVAD VAs were associated with increased risk of all-cause mortality after adjusting for competing risk factors at 60 days (adjusted odds ratio [OR] 1.91, 95% confidence interval [CI] 1.18 to 3.11, p = 0.001), 120 days (adjusted OR 1.97, 95% CI 1.01 to 3.85, p = 0.05), and 180 days (adjusted OR 2.04, 95% CI 1.01 to 4.15, p = 0.05). Using meta-regression analysis, it was found that only history of VA was a risk factor for mortality after LVAD implantation. In conclusion, post-LVAD VA is associated with an increased risk of all-cause mortality with pre-LVAD VAs acting as a risk factor. This meta-analysis, despite being only hypothesis generating, sets the stage for prospective collection of VA information in a prospective device trial or in the Interagency Registry for Mechanically Assisted Circulatory Support.
authors.affiliation: Department of Cardiovascular Medicine, Ohio State's Wexner Medical Center, Columbus, Ohio. Electronic address: nadermakki87@gmail.com.
authors.forename: Nader
authors.initials: N
authors.lastname: Makki
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Olurotimi
authors.initials: O
authors.lastname: Mesubi
authors.affiliation: Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Curtis
authors.initials: C
authors.lastname: Steyers
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Brian
authors.initials: B
authors.lastname: Olshansky
authors.affiliation: Department of Cardiovascular Medicine, Ohio State's Wexner Medical Center, Columbus, Ohio.
authors.forename: William T
authors.initials: WT
authors.lastname: Abraham
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D002423:Cause of Death; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D064887:Observational Studies as Topic; D018570:Risk Assessment; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000628:therapy; D014693:Ventricular Fibrillation / Q000401:mortality / Q000628:therapy*