Rosenbaum Andrew N, Kremers Walter K, Duval Sue, Sakaguchi Scott, John Ranjit, Eckman Peter M
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.
ASAIO J. 2016 May-Jun;62(3):274-80. doi: 10.1097/MAT.0000000000000349.
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.
连续流左心室辅助装置（CF-LVAD）在晚期心力衰竭治疗中的应用日益增加，而心脏植入式电子装置（CIED）的作用尚不清楚。先前关于心律失常和电击发生率的研究常常受到确诊的限制。对178例曾植入CIED且随后植入CF-LVAD的患者进行了检查。收集了病史、用药情况以及来自装置问询的CIED数据。设立了一个心脏手术对照组（n = 38）以控制手术因素。LVAD植入后，一些具有临床意义的事件有所增加：治疗区室性心律失常（VA；p < 0.01）、监测区VA（p < 0.01）、抗心动过速起搏（ATP）终止的发作（p < 0.01）以及电击（p = 0.01），不过后期给予的电击次数减少了（p < 0.01）。植入前存在VA与术后VA相关（优势比[OR]：4.31；置信区间[CI]：1.5 - 12.3，p < 0.01）。与心脏手术相比，LVAD患者经历了更多围手术期事件（即监测到的VA和电击，p < 0.01和p = 0.04）。植入前的植入式心律转复除颤器（ICD）电击以及植入后早期或晚期的心律失常或电击均不能预测生存情况（p = 0.07，p = 0.55，以及p = 0.55）。我们的经验表明，LVAD植入后对具有临床意义的心律失常存在时间依赖性影响，包括有证据显示早期与LVAD相关的心律失常可能是由VAD植入独特的致心律失常作用所引起。
