Clinical characteristics and outcomes of patients with ventricular arrhythmias after continous-flow left ventricular assist device implant

Background: Ventricular arrhythmias (VAs) are observed in 25-50% of continuous-flow left ventricular assist devices (CF-LVAD) recipients, but their role on mortality is debated. Methods: Sixty-nine consecutive patients with a CF-LVAD were retrospectively analyzed. Study endpoints were death and occurrence of first episode of VAs post-CF-LVAD implantation. Early VAs were defined as VAs in the first month after CF-LVAD implantation. Results: During a median follow-up of 29.0 months, 19 patients (27.5 %) died and 18 patients (26.1%) experienced VAs. Three patients experienced early VAs, and one of them died. Patients with cardiac resynchronization therapy (CRT-D) showed a trend towards more VAs (p=0.076), compared to patients without CRT-D; no significant difference in mortality was found between patients with and without CRT-D (p=0.63). Patients with biventricular (BiV) pacing ≥98% experienced more frequently a VAs (p=0.046), with no difference in mortality (p=0.56), compared with patients experiencing BiV pacing<98%. There was no difference in mortality among patients with or without VAs after CF-LVAD [5 patients (27.8%) vs 14 patients (27.5%), p=0.18)], and patients with or without previous history of VAs (p=0.95). Also, there was no difference in mortality among patients with a different timing of implant of implantable cardioverter defibrillator (ICD), before and after CF-LVAD (p=0.11). Conclusions: VAs in CF-LVAD are a common clinical problem, but they do not impact mortality. Timing of ICD implantation do not have significant impact on patients' survival. Patients with BiV pacing ≥98% experienced more frequently a VAs.