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ICD shocks in LVAD patients are not associated with increased subsequent mortality risk

  • Aswini KumarEmail author
  • Varun Tandon
  • David M. O’Sullivan
  • Edmond Cronin
  • Jason Gluck
  • Jeffrey Kluger
Article

Abstract

Background

Implantable cardioverter-defibrillator (ICD) shocks are associated with increased mortality risk in heart failure patients. Whether ICD shocks are associated with mortality in continuous flow LVAD (CF-LVAD) patients is unknown. We studied the relationship of ICD shocks and ventricular arrhythmias (VAs) to morbidity and mortality in CF-LVAD-supported patients in our institution.

Methods

Single-center, retrospective study of prospectively collected ICD and LVAD databases. We analyzed data on VA which received ICD therapy in patients who underwent CF-LVAD implantation at Hartford Hospital between 2008 and 2018.

Results

A total of 157 patients were studied. During a median follow-up of 10 months (interquartile range 5–20 months), 48 patients (30.6%) experienced post-LVAD sustained VA. Thirty patients (19.1%) had appropriate shocks for VA and 5 patients (3.1%) had inappropriate shocks. Shocks for any arrhythmia were not associated with an increased risk of death (OR 0.836, 95% CI 0.224–3.115, p = 0.789). Neither post-LVAD VA nor the rate of VA was associated with an increased mortality risk (OR 0.662 [0.329–1.334], p = 0.248; OR 1.001 [0.989–1.014], p = 0.817, respectively). Cox multivariate regression analysis revealed pre-LVAD VA as a significant predictor of VA post LVAD implantation (OR 3.284 [1.584–6.808], p = 0.001). Symptoms with VA occurred in 22 (45.8%) patients, ranging from palpitations to near syncope/syncope. None of the variables including the rate of VA was associated with death or symptoms.

Conclusions

VAs are common in CF-LVAD patients and occur with higher frequency in those with pre-LVAD VA and frequently cause symptoms. Neither VA nor ICD shocks are associated with mortality risk.

Keywords

LVAD Ventricular arrhythmia ICD shocks Mortality Symptoms 

Abbreviations

LVAD

Left ventricular assist device

VA

Ventricular arrhythmia

DT

Destination therapy

BTT

Bridge to transplant

BTD

Bridge to decision

ATP

Anti-tachycardia pacing

Notes

Acknowledgments

We thank Poojita Shivamurthy, MD (Mount Sinai Hospital, NY), for her initial work in the study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Hartford HealthCare Institutional Review Board.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of CardiologyHartford HospitalHartfordUSA
  2. 2.Department of MedicineUniversity of ConnecticutFarmingtonUSA
  3. 3.Department of Research AdministrationHartford HealthCareHartfordUSA
  4. 4.University of Connecticut School of MedicineFarmingtonUSA

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