Varghese Jobin, Gill Jashan, Munshi Rezwan, Roukoz Henri, Trivedi Jaimin R, Bhan Adarsh, Ravichandran Ashwin, Cowger Jennifer, Sandesara Chirag, Dhawan Rahul, Vijayakrishnan Rajakrishnan, Slaughter Mark S, Ahmed Mustafa M, Gopinathannair Rakesh
MercyOne North Iowa Medical Center, Mason City, Iowa, USA.
University of Minnesota, Minneapolis, Minnesota, USA.
J Cardiovasc Electrophysiol. 2025 Jul 31. doi: 10.1111/jce.70033.
Ventricular arrhythmias (VAs) are common in patients with left ventricular assist devices (LVADs), but their prognostic impact remains uncertain. Prior studies have yielded conflicting results regarding their association with mortality and morbidity. We aimed to evaluate the incidence and clinical outcomes associated with VAs in a large, multicenter LVAD cohort.
We analyzed 408 patients who underwent LVAD implantation across five centers between 2007 and 2015. VA was defined as sustained VAs lasting > 30 s or requiring ICD therapy. The effects of pre- and post-LVAD VA on clinical outcomes-including survival, hospitalizations, and ICD shocks-were assessed.
Of 408 patients, 254 (62%) had a history of pre-LVAD VA. Compared to those without prior VA, patients with pre-LVAD VA were more likely to be male (85% vs. 75%, p = 0.02), receive amiodarone (44% vs. 31%, p = 0.01), and have larger left ventricular end-diastolic dimension (LVEDD) (7.1 vs. 6.8 cm, p = 0.01). Postimplant, the pre-VA group had a significantly higher incidence of VA (73% vs. 37%, p < 0.0001), atrial arrhythmias (63% vs. 42%, p < 0.0001), ICD shocks (41% vs. 32%, p = 0.001), and cardiac hospitalizations (median 0.20 vs. 0.08 events/year, p = 0.0003). However, Kaplan-Meier survival analysis showed no significant difference in overall mortality (log-rank p = 0.10). On multivariate Cox regression, pre-LVAD VA predicted post-LVAD VA, but LVEDD was the only independent predictor of mortality.
In this multicenter cohort, pre-LVAD VAs were strongly associated with postimplant arrhythmic burden and increased morbidity, but not with long-term mortality. These findings highlight the importance of structural factors such as LVEDD over arrhythmia history in survival outcomes and underscore the need for individualized arrhythmia surveillance and management strategies in LVAD recipients with prior VAs.
室性心律失常（VA）在左心室辅助装置（LVAD）患者中很常见，但其预后影响仍不确定。先前的研究在其与死亡率和发病率的关联方面得出了相互矛盾的结果。我们旨在评估大型多中心LVAD队列中VA的发生率及其相关临床结局。
我们分析了2007年至2015年间在五个中心接受LVAD植入的408例患者。VA定义为持续时间超过30秒的持续性VA或需要ICD治疗的VA。评估LVAD植入前后VA对临床结局（包括生存率、住院次数和ICD电击）的影响。
408例患者中，254例（62%）有LVAD植入前VA病史。与无既往VA的患者相比，有LVAD植入前VA的患者更可能为男性（85%对75%，p = 0.02），接受胺碘酮治疗（44%对31%，p = 0.01），且左心室舒张末期内径（LVEDD）更大（7.1对6.8 cm，p = 0.01）。植入后，植入前有VA的组VA发生率显著更高（73%对37%，p < 0.0001）、房性心律失常发生率更高（63%对42%，p < 0.0001）、ICD电击发生率更高（41%对32%，p = 0.001）以及心脏住院次数更多（中位数0.20对0.08次/年，p = 0.0003）。然而，Kaplan-Meier生存分析显示总体死亡率无显著差异（对数秩检验p = 0.10）。在多变量Cox回归分析中，LVAD植入前VA可预测植入后VA，但LVEDD是死亡率的唯一独立预测因素。
在这个多中心队列中，LVAD植入前VA与植入后心律失常负担及发病率增加密切相关，但与长期死亡率无关。这些发现凸显了诸如LVEDD等结构因素在生存结局方面优于心律失常病史的重要性，并强调了对有既往VA的LVAD接受者进行个体化心律失常监测和管理策略的必要性。
