Heart Center Leipzig, Department of Electrophysiology, Leipzig, Germany.
Heart Center Leipzig, Department of Cardiac Surgery, Leipzig, Germany.
Heart Rhythm. 2017 Dec;14(12):1812-1819. doi: 10.1016/j.hrthm.2017.07.027. Epub 2017 Jul 27.
Ventricular arrhythmias (VAs) are common in patients after left ventricular assist device (LVAD) implantation.
The purpose of this study was to determine the predictors of VAs and their impact on mortality in LVAD patients.
A total of 98 consecutive patients with an implantable cardioverter-defibrillator (ICD) (86 [88%] male, mean age 57 ± 10 years), 57 [58%] with nonischemic dilated cardiomyopathy) who had received an LVAD between May 2011 and December 2013 at our institution were included in the study.
Mean left ventricular ejection fraction and left ventricular end-diastolic diameter were 20% ± 8% and 73 ± 11 mm, respectively. Seventy-three patients (75%) had atrial fibrillation (AF). During the 12 months before LVAD implantation, 38 patients (39%) had experienced ≥1 episode of VAs (11.5 ± 20) requiring ICD therapies. The number of patients with VAs was comparable among all types of ICDs (P = .48). During the 12-month follow-up after LVAD implantation, 48 patients (49%) experienced ≥1 episode of VAs (30 ± 98) with appropriate ICD therapies. The prevalence of VAs was significantly higher among patients with pre-LVAD VAs compared to those without VAs during the year before LVAD implantation (66% vs 38%; P = .008). In a binary multiple logistic regression analysis, pre-LVAD VAs (hazard ratio 5.36, 95% confidence interval 2.0-14.3; P = .001) and AF (hazard ratio 3.1, 95% confidence interval 1.1-11.9; P = .024) predicted post-LVAD VAs.
Pre-LVAD VAs and AF predict the occurrence of VAs after LVAD implantation. According to the latest data on the negative impact of post-LVAD VAs on all-cause mortality, further studies should clarify the reasonability of maintaining sinus rhythm in patients with AF and/or prophylactic catheter ablation of ventricular tachycardias before LVAD implantation.
左心室辅助装置（LVAD）植入后患者常发生室性心律失常（VA）。
本研究旨在确定 VA 的预测因素及其对 LVAD 患者死亡率的影响。
本研究纳入了 2011 年 5 月至 2013 年 12 月在我院接受植入式心律转复除颤器（ICD）治疗的 98 例连续患者（86%为男性，平均年龄 57±10 岁，57%为非缺血性扩张型心肌病）。
平均左心室射血分数和左心室舒张末期直径分别为 20%±8%和 73±11mm。73 例（75%）患者存在心房颤动（AF）。在 LVAD 植入前 12 个月内，38 例（39%）患者经历了≥1 次 VA 发作（11.5±20），需要 ICD 治疗。所有类型的 ICD 中 VA 患者数量相当（P=0.48）。在 LVAD 植入后 12 个月的随访期间，48 例（49%）患者经历了≥1 次 VA 发作（30±98），需要 ICD 治疗。与 LVAD 植入前 1 年内无 VA 发作的患者相比，LVAD 植入前有 VA 发作的患者 VA 发生率显著更高（66% vs 38%；P=0.008）。在二元多变量逻辑回归分析中，LVAD 前 VA（危险比 5.36，95%置信区间 2.0-14.3；P=0.001）和 AF（危险比 3.1，95%置信区间 1.1-11.9；P=0.024）预测 LVAD 后 VA。
LVAD 前 VA 和 AF 预测 LVAD 后 VA 的发生。根据 LVAD 后 VA 对全因死亡率的负面影响的最新数据，进一步的研究应该阐明在 LVAD 植入前保持 AF 窦性心律和/或预防性导管消融室性心动过速的合理性。
