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CLINICAL RESEARCH: VENTRICULAR ASSIST DEVICES

Effects of Left Ventricular Assist Device Therapy on Ventricular Arrhythmias

Ohad Ziv, MD^_*, Jose Dizon, MD, FACC, Amit Thosani, MD^_*, Yoshifumi Naka, MD, PhD, Anthony R. Magnano, MD, MPH and Hasan Garan, MD, FACC^,_*

^_* Department of Medicine, Columbia University, New York, New York
Division of Cardiology, Columbia University, New York, New York
Department of Cardiothoracic Surgery, Columbia University, New York, New York.

Manuscript received June 22, 2004; revised manuscript received November 6, 2004, accepted January 25, 2005.

^_* Reprint requests and correspondence: Dr. Hasan Garan, Director of Clinical Cardiac Electrophysiology, Professor of Medicine, Columbia Presbyterian Medical Center, 161 Fort Washington Avenue, Suite 551, New York, New York 10032. (Email: hg2017{at}columbia.edu).

OBJECTIVES: In a retrospective study, we sought to evaluate the effect of left ventricular assist device (LVAD) therapy on ventricular tachyarrhythmias in patients with advanced congestive heart failure.

BACKGROUND: Despite the increasing use of LVAD as a bridge to cardiac transplantation, our knowledge regarding its effect on ventricular arrhythmias is currently limited to small series. Little is known about the prevalence, predictors, and clinical consequences of ventricular arrhythmias in LVAD recipients.

METHODS: We reviewed the pre- and post-LVAD course of the last 100 consecutive adult patients to receive a HeartMate LVAD (Thoratec Laboratories Corp., Pleasanton, California) at our institution. All ventricular arrhythmias sustained for at least 30 s or requiring defibrillation were analyzed. All documented pre- and post-LVAD sustained ventricular arrhythmias were classified either as monomorphic ventricular tachycardia (MVT) or polymorphic ventricular tachycardia (PVT)/ventricular fibrillation (VF).

RESULTS: Our population had an average age of 51 years, had predominately ischemic cardiomyopathy (63%), and a mean left ventricular ejection fraction of 20 ± 10%. New-onset MVT was observed in 18 patients who did not have MVT before LVAD placement. After LVAD, new-onset MVT was 4.5 times more likely than elimination of previously present MVT (p = 0.001), whereas the effect of LVAD on incidence of PVT/VF was not significant. In a multivariate Cox proportional hazards regression analysis, serum electrolyte abnormality was an independent predictor of post-LVAD ventricular arrhythmias. Preoperative MVT did not predict postoperative MVT.

CONCLUSIONS: After LVAD placement, there is a significant rise in the incidence of de novo MVT. By contrast, the incidence of PVT/VF was unaffected by LVAD placement.

Abbreviations and Acronyms   ECG = electrocardiogram   ICD = implantable cardioverter-defibrillator   LV = left ventricular   LVAD = left ventricular assist device   LVEF = left ventricular ejection fraction   MVT = monomorphic ventricular tachycardia   PVT = polymorphic ventricular tachycardia   RVAD = right ventricular assist device   VF = ventricular fibrillation

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