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- Title
Risk of Mortality for Ventricular Arrhythmia in Ambulatory LVAD Patients.
- Authors
BRENYO, ANDREW; RAO, MOHAN; KONERU, SUSHMA; HALLINAN, WILLIAM; SHAH, SAMIT; MASSEY, H. T.; CHEN, LEWAY; POLONSKY, BRONISLAVA; MCNITT, SCOTT; HUANG, DAVID T.; GOLDENBERG, ILAN; AKTAS, MEHMET
- Abstract
Risk of Mortality for Ventricular Arrhythmia. Background: There are limited data regarding the incidence and prognostic significance of ventricular arrhythmias (VA) in ambulatory continuous flow left ventricular assist device (LVAD) patients. Methods: Sixty-one consecutive patients from November 1, 2006 through December 31, 2010 with an LVAD and implantable cardioverter defibrillator that survived to discharge from the LVAD implantation admission were studied. Follow-up began from date of discharge with both devices in situ and ended with death, transplant, on June 1, 2011. Pre-LVAD VA history was related to the primary endpoints of post-LVAD VA, mortality, and the combined endpoint of post-LVAD VA/mortality. Results: During a mean follow-up of 622 days 19 patients (31%) experienced VA (14 episodes of VT, 5 episodes of VF). Pre-LVAD VA was predictive of post-LVAD VA (hazard ratio [HR] 2.91, P = 0.026) and the combined post-LVAD VA/mortality endpoint (HR 2.70, P = 0.021) but only displayed a nonsignificant association with mortality (HR 2.30, P = 0.11). In multivariate analysis, pre-LVAD VA remained a significant predictor of post-LVAD VA (HR 2.84, P = 0.03) and the combined post-LVAD VA/mortality endpoint (HR 2.65, P = 0.025). Post-LVAD VA was the strongest univariate predictor of mortality (HR 13.92, P < 0.001) and remained so after multivariate adjustment (HR 9.69, P = 0.001). Post-LVAD VA occurred at a mean of 1 year from mortality events with 45% within 1 month. Conclusions: Pre-LVAD VA is a significant predictor of post-LVAD VA but not of mortality. VA in the continuous flow LVAD population carries a significant risk of mortality often within the first month. (J Cardiovasc Electrophysiol, Vol. 23, pp. 515-520, May 2012)
- Subjects
NEW York (State); MORTALITY risk factors; ACADEMIC medical centers; CATHETERIZATION complications; CHI-squared test; CONFIDENCE intervals; LEFT heart ventricle; IMPLANTABLE cardioverter-defibrillators; MULTIVARIATE analysis; HEALTH outcome assessment; STATISTICS; SURVIVAL analysis (Biometry); T-test (Statistics); THROMBOSIS; TREATMENT effectiveness; DISEASE incidence; PROPORTIONAL hazards models; RETROSPECTIVE studies; HEART assist devices; DATA analysis software; DESCRIPTIVE statistics; KAPLAN-Meier estimator; VENTRICULAR arrhythmia; PROGNOSIS
- Publication
Journal of Cardiovascular Electrophysiology, 2012, Vol 23, Issue 5, p515
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/j.1540-8167.2011.02223.x