Section of Cardiology, Department of Medicine, Heart and Vascular Center, University of Chicago Medical Center, Chicago, Illinois.
Division of Cardiovascular Medicine, Department of Internal Medicine, Samuel and Jean Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA.
Curr Opin Cardiol. 2020 May;35(3):276-281. doi: 10.1097/HCO.0000000000000729.
Atrial arrhythmias commonly occur in patients with advanced heart failure with reduced ejection fraction (HFrEF) who require left ventricular assist devices (LVADs) implantation. This review summarizes the current literature regarding the incidence, prevalence, and predictors of atrial arrhythmias in LVAD patients and its impact on the clinical outcomes. Moreover, we review the mechanisms and management strategies of atrial arrhythmias in this population.
Atrial arrhythmias including atrial fibrillation, atrial flutter, and atrial tachycardia are highly prevalent in patients with advanced HFrEF before or after the LVAD implantation. Atrial arrhythmias have a significant impact on overall clinical outcome including survival, heart failure hospitalization, quality of life, thromboembolic events and resource utilization. Atrial fibrillation and other atrial arrhythmias frequently coexist in this population. In patients with atrial arrhythmias and LVAD, anticoagulation and cardiovascular implantable electronic devices should be closely monitored and managed to prevent thromboembolic events or inappropriate shocks. Rhythm and rate control strategies are comparable regarding overall clinical outcomes in this population. LVADs induce favorable atrial remodeling in patients with HFrEF.
Atrial arrhythmias are highly common in LVAD patients and have significant impact on overall clinical outcomes. Further studies are needed to determine optimal management and prevention of atrial arrhythmias in LVAD population.
在需要植入左心室辅助装置（LVAD）的射血分数降低的心力衰竭（HFrEF）晚期患者中，常发生房性心律失常。本文总结了 LVAD 患者房性心律失常的发生率、患病率和预测因素及其对临床结局的影响的相关文献，同时还综述了该人群中心律失常的发生机制和管理策略。
在 LVAD 植入前或植入后，HFrEF 晚期患者中常见房性心律失常，包括心房颤动、心房扑动和房性心动过速。房性心律失常对整体临床结局（包括生存率、心力衰竭住院、生活质量、血栓栓塞事件和资源利用）有显著影响。在该人群中，心房颤动和其他房性心律失常常同时存在。对于合并房性心律失常和 LVAD 的患者，应密切监测和管理抗凝和心血管植入电子设备，以预防血栓栓塞事件或不适当的电击。在该人群中，节律和心率控制策略的整体临床结局相当。LVAD 可诱导 HFrEF 患者的有利心房重构。
房性心律失常在 LVAD 患者中非常常见，对整体临床结局有重大影响。需要进一步研究以确定 LVAD 人群中房性心律失常的最佳管理和预防措施。
