Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France.
Department of Cardiology and Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, Lille, France.
JACC Clin Electrophysiol. 2019 Aug;5(8):944-954. doi: 10.1016/j.jacep.2019.05.025. Epub 2019 Aug 19.
This study aimed to evaluate incidence, clinical significance, and predictors of early ventricular arrhythmias (VAs) in left ventricular assist device (LVAD) recipients.
LVAD implantation is increasingly used in patients with end-stage heart failure. Early VAs may occur during the 30-day post-operative period, but many questions remain unanswered regarding their incidence and clinical impact.
This observational study was conducted in 19 centers between 2006 and 2016. Early VAs were defined as sustained ventricular tachycardia and/or ventricular fibrillation occurring <30 days post-LVAD implantation and requiring appropriate implantable cardioverter-defibrillator therapy, external electrical shock, or medical therapy.
A total of 652 patients (median age: 59.8 years; left ventricular ejection fraction: 20.7 ± 7.4%; HeartMate 2: 72.8%; HeartWare: 19.5%; Jarvik 2000: 7.7%) were included in the analysis. Early VAs occurred in 162 patients (24.8%), most frequently during the first week after LVAD implantation. Multivariable analysis identified history of VAs prior to LVAD and any combined surgery with LVAD as 2 predictors of early VAs. The occurrence of early VAs with electrical storm was the strongest predictor of 30-day post-operative mortality, associated with a 7-fold increase of 30-day mortality. However, in patients discharged alive from hospital, occurrence of early VAs did not influence long-term survival.
Early VAs are common after LVAD implantation and increase 30-day post-operative mortality, without affecting long-term survival. Further studies will be needed to analyze whether pre- or pre-operative ablation of VAs may improve post-operative outcomes. (Determination of Risk Factors of Ventricular Arrhythmias After Implantation of Continuous Flow Left Ventricular Assist Device With Continuous Flow Left Ventricular Assist Device [ASSIST-ICD]; NCT02873169).
本研究旨在评估左心室辅助装置（LVAD）接受者早期室性心律失常（VA）的发生率、临床意义和预测因素。
LVAD 植入术在终末期心力衰竭患者中的应用日益增多。早期 VA 可能发生在术后 30 天内，但关于其发生率和临床影响仍有许多问题尚未得到解答。
本观察性研究于 2006 年至 2016 年在 19 个中心进行。早期 VA 定义为 LVAD 植入后<30 天发生的持续性室性心动过速和/或心室颤动，并需要适当的植入式心脏复律除颤器治疗、外部电击或药物治疗。
共纳入 652 例患者（中位年龄：59.8 岁；左心室射血分数：20.7±7.4%；HeartMate 2：72.8%；HeartWare：19.5%；Jarvik 2000：7.7%）进行分析。162 例（24.8%）患者发生早期 VA，最常发生在 LVAD 植入后第一周内。多变量分析确定 LVAD 前 VA 病史和任何与 LVAD 联合的手术是早期 VA 的 2 个预测因素。早期 VA 伴电风暴是术后 30 天死亡率的最强预测因素，与 30 天死亡率增加 7 倍相关。然而，在存活出院的患者中，早期 VA 的发生并不影响长期生存。
LVAD 植入后早期 VA 很常见，增加了术后 30 天死亡率，但不影响长期生存。需要进一步研究来分析 VA 的术前或术前消融是否可能改善术后结局。（连续血流左心室辅助装置植入后室性心律失常危险因素的确定[ASSIST-ICD]；NCT02873169）。
