Background: End stage heart failure patients treated with continuous flow left ventricular assist device (LVAD) have a high incidence of atrial (AA) and ventricular (VA) arrhythmias. The role of left ventricular (LV) remodeling on arrhythmic outcomes post-LVAD remains unclear.
Objective: The aim of the study was to evaluate improvement in LV dimensions and its association with post-LVAD AA, VA and implantable-cardioverter defibrillator (ICD) shocks.
Methods: A multi-center LVAD cardiac arrhythmia database was queried to identify patients who had LVAD implant between 2010 and 2015. The cohort was divided into 2 groups based on post-LVAD LV end-diastolic dimension (LVEDD) changes (improvement group and non-improvement group). Demographic and risk factors were evaluated between the groups. The primary outcome measures were post-LVAD AA, VA, and ICD shocks.
Results: A total of 419 patients were included in the final dataset of which 355 patients had some improvement in their post-LVAD LVEDD and 64 patients had no improvement. The median age, gender, pre-LVAD LV ejection fraction and use of ICDs were similar between the improvement and non-improvement groups (Table 1). The patients in improvement group were more likely to get post-LVAD AA (53% vs. 37%, p<0.01); however, the rates of VA and ICD shocks post-LVAD were comparable (Table 1).
Conclusion: The majority of LVAD recipients patients have improvement in their LV dimensions post-LVAD; however,this is not associated with reduced post-LVAD arrhythmias or ICD shocks.
Comparison of post-LVAD LVEDD improvement group to rest of patients | LVEDD Improvement Group (n= 355) | LVEDD Non-Improvement Group (n= 64) | p-value |
| Age | 61 (51-68) | 56 (47-64) | 0.06 |
| Female gender | 20% | 18% | 0.7 |
| Patients with ICD before LVAD implantation | 49% | 45% | 0.55 |
| Pre-LVAD left ventricular ejection fraction | 15 (11-20) | 15 (12-20) | 0.39 |
| Pre-LVAD left ventricular end-diastolic dimension | 7.1 (6.5-7.7) | 6.8 (6.1-7.5) | 0.03 |
| Pre-LVAD left ventricular end-systolic dimension | 6.4 (5.7-7.2) | 6.1 (5.5-7.0) | 0.09 |
| Post-LVAD atrial arrhythmias | 53% | 37% | 0.03 |
| Post-LVAD ventricular arrhythmias | 55% | 43% | 0.11 |
| Post-LVAD ICD shocks | 35% | 33% | 0.79 |
