1
|
Oates CP, Lawrence LL, Bigham GE, Meda NS, Basyal B, Rao SD, Hadadi CA, Najjar SS, Shah MH, Sheikh FH, Lam PH. Impact of Cardiac Resynchronization Therapy on Ventricular Arrhythmias and Survival After Durable Left Ventricular Assist Device Implantation. ASAIO J 2024:00002480-990000000-00532. [PMID: 39074441 DOI: 10.1097/mat.0000000000002279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
The impact of cardiac resynchronization therapy (CRT) in patients receiving durable left ventricular assist device (LVAD) implantation remains unclear and there is no consensus regarding postoperative management. We sought to determine the impact of postoperative management of CRT on clinical outcomes following LVAD implantation. A total of 789 patients underwent LVAD implantation at our institution from 2007 to 2022 including 195 patients (24.7%) with preoperative CRT. Patients with preoperative CRT were significantly older and more frequently received an LVAD as destination therapy compared to patients without preoperative CRT. After LVAD implantation, 85 patients had CRT programmed "off" and 74 patients had CRT programmed "on." The risk of mortality was significantly increased amongst patients with preoperative CRT that was turned "on" following LVAD implantation compared to patients with preoperative CRT turned "off" following implant (subdistribution hazard ratio [sdHR] = 1.54; 1.06-2.37 95% confidence interval [CI]; p = 0.036). There was no significant difference between incidence of ventricular arrhythmias in patients with and without postoperative CRT "on" (35.1% vs. 48.2%; p = 0.095). Additional clinical trials are warranted to determine the best CRT programming strategy following LVAD implantation.
Collapse
Affiliation(s)
- Connor P Oates
- From the MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Luke L Lawrence
- From the MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Grace E Bigham
- From the MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Namratha S Meda
- From the MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Binaya Basyal
- From the MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Sriram D Rao
- From the MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia
- Georgetown University School of Medicine, Washington, District of Columbia
- MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Cyrus A Hadadi
- From the MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Samer S Najjar
- From the MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Manish H Shah
- From the MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Farooq H Sheikh
- From the MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Phillip H Lam
- From the MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia
- Georgetown University School of Medicine, Washington, District of Columbia
| |
Collapse
|
2
|
Rordorf R, Pignalosa L, Casula M, Perna E, Baroni M, Garascia A, Guida S, Gazzoli F, Pini D, Cannata F, Pellegrino M, Vittori C, De Filippo P, Malanchini G, Vergara P, Della Bella P, Gulletta S. Real-world data of patients affected by advanced heart failure treated with implantable cardioverter defibrillator and left ventricular assist device: Results of a multicenter observational study. Artif Organs 2024; 48:525-535. [PMID: 38213270 DOI: 10.1111/aor.14708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/16/2023] [Accepted: 12/26/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Left ventricular assist device (L-VAD) implantation is increasingly used in patients with heart failure (HF) and most patients also have an implantable cardioverter defibrillator (ICD). Limited data are available on the incidence of ICD therapies and complications in this special setting. The aim of this study was to analyze the real-world incidence and predictors of ICD therapies, complications and interactions between ICD and L-VAD. METHODS We conducted a multicenter retrospective observational study in patients with advanced HF implanted with ICD and a continuous-flow L-VAD, followed-up in five advanced HF centers in Northern Italy. RESULTS A total of 234 patients (89.7% male, median age 59, 48.3% with ischemic etiology) were enrolled. After a median follow-up of 21 months, 66 patients (28.2%) experienced an appropriate ICD therapy, 22 patients (9.4%) an inappropriate ICD therapy, and 17 patients (7.3%) suffered from an interaction between ICD and L-VAD. The composite outcome of all ICD-related complications was reported in 41 patients (17.5%), and 121 (51.7%) experienced an L-VAD-related complication. At multivariable analysis, an active ventricular tachycardia (VT) zone and a prior ICD generator replacement were independent predictors of ICD therapies and of total ICD-related complications, respectively. CONCLUSIONS Real-world patients with both L-VAD and ICD experience a high rate of ICD therapies and complications. Our findings suggest the importance of tailoring device programming in order to minimize the incidence of unnecessary ICD therapies, thus sparing the need for ICD generator replacement, a procedure associated to a high risk of complications.
Collapse
Affiliation(s)
- Roberto Rordorf
- Arrhythmia and Electrophysiology Unit, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | - Leonardo Pignalosa
- Arrhythmia and Electrophysiology Unit, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | - Matteo Casula
- Arrhythmia and Electrophysiology Unit, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | - Enrico Perna
- De Gasperis CardioCenter, Niguarda Hospital, Milan, Italy
| | - Matteo Baroni
- De Gasperis CardioCenter, Niguarda Hospital, Milan, Italy
| | | | - Stefania Guida
- Division of Cardiology, IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Fabrizio Gazzoli
- Division Cardiac Surgery, IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Daniela Pini
- Department of Perioperative Cardiology and Cardiovascular imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Francesco Cannata
- Department of Perioperative Cardiology and Cardiovascular imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marta Pellegrino
- Department of Perioperative Cardiology and Cardiovascular imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Claudia Vittori
- Division of Cardiology, Ospedale Giovanni XXIII, Bergamo, Italy
| | | | | | - Pasquale Vergara
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele University Hospital, Milan, Italy
| | - Paolo Della Bella
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele University Hospital, Milan, Italy
| | - Simone Gulletta
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele University Hospital, Milan, Italy
| |
Collapse
|
3
|
Soni B, Gopinathannair R. Managing ventricular arrhythmias and implantable cardiac defibrillator shocks after left ventricular assist device implantation. J Cardiovasc Electrophysiol 2024; 35:592-600. [PMID: 38013210 DOI: 10.1111/jce.16142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
Continuous flow left ventricular assist devices (CF-LVADs) have been shown to reduce mortality and morbidity in patients with advanced heart failure with reduced ejection fraction. However, ventricular arrhythmias (VA) are common, are mostly secondary to underlying myocardial scar, and have a higher incidence in patients with pre-LVAD VA. Sustained VA is well tolerated in the LVAD patient but can result in implantable defibrillator (ICD) shocks, right ventricular failure, hospitalizations, and reduced quality of life. There is limited data regarding best practices for the medical management of VA as well as the role for procedural interventions in patients with uncontrolled VA and/or ICD shocks. Vast majority of CF-LVAD patients have a preexisting cardiovascular implantable electronic device (CIED) and ICD and/or cardiac resynchronization therapies are continued in many. Several questions, however, remain regarding the efficacy of ICD and CRT following CF-LVAD. Moreover, optimal CIED programming after CF-LVAD implantation. Therefore, the primary objective of this review article is to provide the most up-to-date evidence and to provide guidance on the clinical significance, pathogenesis, predictors, and management strategies for VA and ICD therapies in the CF-LVAD population. We also discuss knowledge gaps as well as areas for future research.
Collapse
Affiliation(s)
- Bosky Soni
- Department of Medicine, University of Pittsburgh School of Medicine, Harrisburg, Pennsylvania, USA
| | | |
Collapse
|
4
|
Pausch J, Mersmann J, Bhadra OD, Barten MJ, Tönnis T, Yildirim Y, Pecha S, Reichenspurner H, Bernhardt AM. Prognostic impact of implantable cardioverter defibrillators and associated adverse events in patients with continuous flow left ventricular assist devices. Front Cardiovasc Med 2023; 10:1158248. [PMID: 37332585 PMCID: PMC10272823 DOI: 10.3389/fcvm.2023.1158248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
Objectives Implantation of implantable cardioverter defibrillators (ICD) reduces the risk of all-cause mortality in symptomatic heart failure (HF) patients with severe left ventricular (LV) dysfunction. Nevertheless, the prognostic impact of ICD therapy in continuous flow left ventricular assist device (LVAD) recipients remains controversial. Methods 162 consecutive HF patients, who underwent LVAD implantation at our institution between 2010 and 2019, were categorized according to the presence (n = 94, ICD-group) or absence (n = 68, Control-group) of ICDs. Apart from clinical baseline and follow-up parameters, adverse events (AEs) related to ICD therapy and overall survival rates were retrospectively analyzed. Results Out of 162 consecutive LVAD recipients 79 patients (48.8%) were preoperatively categorized as Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile ≤2. The prevalence of severe HF symptoms and preoperative use of short-term circulatory support devices (54.4% vs. 13.8%, p < 0.001) was higher within the Control-group, although baseline severity of LV and RV dysfunction was similar. Apart from an increased prevalence of perioperative right heart failure (RHF) within the Control-group (45.6% vs. 17.0%; p < 0.001), procedural characteristics and perioperative outcome were similar. Overall-survival during a median follow-up of 14 (3.0-36.5) months was similar within both groups (p = 0.46). During the first 2 years after LVAD implantation 53 ICD-related AEs occurred within the ICD-group. Thereof, lead-dysfunction occurred in 19 patients and unplanned ICD-reintervention in 11 patients. Furthermore, in 18 patients appropriate shocks without loss of consciousness occurred, whereas inappropriate shocks occurred in 5 patients. Conclusion ICD therapy in LVAD recipients was not associated with a survival benefit or reduced morbidity after LVAD implantation. Conservative ICD-programming seems to be justified to avoid ICD-related complications and "awake shocks" after LVAD implantation.
Collapse
Affiliation(s)
- Jonas Pausch
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Mersmann
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver D. Bhadra
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus J. Barten
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Tönnis
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yalin Yildirim
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander M. Bernhardt
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
5
|
Gopinathannair R. Another Strike Against Continuing Cardiac Resynchronization Therapy in Left Ventricular Assist Device recipients? J Cardiovasc Electrophysiol 2022; 33:1032-1033. [PMID: 35245412 DOI: 10.1111/jce.15439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
Continuous flow left ventricular assist devices (LVAD) are an important therapeutic strategy, either as a bridge to transplant, bridge to recovery or as destination therapy, in patients with end-stage heart failure. This article is protected by copyright. All rights reserved.
Collapse
|