title: Arrhythmias in Patients with Cardiac Implantable Electrical Devices after Implantation of a Left Ventricular Assist Device.
abstract: Utilization of continuous-flow left ventricular assist devices (CF-LVADs) for advanced heart failure is increasing, and the role of cardiac implantable electrical devices (CIED) is unclear. Prior studies of the incidence of arrhythmias and shocks are frequently limited by ascertainment. One hundred and seventy-eight patients were examined with a previous CIED who were implanted with a CF-LVAD. Medical history, medications, and CIED data from device interrogations were gathered. A cardiac surgery control group (n = 38) was obtained to control for surgical factors. Several clinically significant events increased after LVAD implantation: treated-zone ventricular arrhythmias (VA; p < 0.01), monitored-zone VA (p < 0.01), antitachycardia pacing (ATP)-terminated episodes (p < 0.01), and shocks (p = 0.01), although administered shocks later decreased (p < 0.01). Presence of a preimplant VA was associated with postoperative VA (odds ratio [OR]: 4.31; confidence interval [CI]: 1.5-12.3, p < 0.01). Relative to cardiac surgery, LVAD patients experienced more perioperative events (i.e., monitored VAs and shocks, p < 0.01 and p = 0.04). Neither implantable cardioverter defibrillator (ICD) shocks before implant nor early or late postimplant arrhythmias or shocks predicted survival (p = 0.07, p = 0.55, and p = 0.55). Our experience demonstrates time-dependent effects on clinically significant arrhythmias after LVAD implantation, including evidence that early LVAD-related arrhythmias may be caused by the unique arrhythmogenic effects of VAD implant.
authors.affiliation: From the *Department of Medicine, †Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; ‡Lillehei Clinical Research Unit, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota; §Cardiovascular Division, Department of Medicine, ¶Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota; and ‖Minneapolis Heart Institute, Minneapolis, Minnesota.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Rosenbaum
authors.forename: Walter K
authors.initials: WK
authors.lastname: Kremers
authors.forename: Sue
authors.initials: S
authors.lastname: Duval
authors.forename: Scott
authors.initials: S
authors.lastname: Sakaguchi
authors.forename: Ranjit
authors.initials: R
authors.lastname: John
authors.forename: Peter M
authors.initials: PM
authors.lastname: Eckman
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies