Clinical dilemmas and innovation
Incidence of Ventricular Arrhythmias in Patients on Long-term Support With a Continuous-flow Assist Device (HeartMate II)

https://doi.org/10.1016/j.healun.2009.03.011Get rights and content

The incidence of ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients supported with a continuous-flow left ventricular assist device (LVAD) has not been investigated in detail. In 23 consecutive recipients of a HeartMate II, we analyzed the incidence of VT/VF during a total of 266 months of follow-up. Sustained VT or VF occurred in 52% of the patients, with the majority of arrhythmias occurring in the first 4 weeks after LVAD implantation. VT/VF requiring implantable cardioverter-defibrillator (ICD) shock or external defibrillation occurred in 8 patients and significant hemodynamic instability ensued in 3 patients. There were no clear predictors of VT/VF, and it is argued that prophylactic ICD implantation should be considered in patients supported with a continuous-flow LVAD.

Section snippets

Subjects

We reviewed the hospital records of 23 consecutive recipients of a HMII (Thoratec, Pleasanton, CA) who were implanted at Rigshospitalet, Copenhagen, from March 2006 to July 2008. The mean duration of support was 341 days (range 6 to 802 days). Patient charts and implantable cardioverter-defibrillator (ICD) memory interrogation reports were reviewed. Indications for device implantation included bridge to transplantation in 19 patients and destination therapy in 4 patients. Baseline

Results

Five (22%) patients had sustained VT or VF before HMII implantation. After HMII implantation, 12 of the 23 patients (52%) had sustained ventricular arrhythmias that were treated either by the ICD (n = 7), required external defibrillation (n = 4, including 3 non-ICD patients and 1 ICD patient with slow VT) or resolved spontaneously (n = 1). Of the 12 patients with VT/VF, 4 had documented arrhythmia before HMII surgery and 8 had new-onset arrhythmia. Patients with ischemic heart disease (IHD) did

Discussion

The study shows that VT/VF is common in patients supported with a continuous-flow LVAD, especially in the early post-operative period. In fact, half of the patients had ventricular arrhythmias requiring treatment. Although most episodes were symptomatic they were generally well tolerated. We observed no deaths due to ventricular arrhythmia. There is a paucity of data on VT/VF in patients supported with a continuous-flow LVAD. In the HMII bridge-to-transplant approval study, 32 of the 133

References (9)

There are more references available in the full text version of this article.

Cited by (0)

View full text
Copyright © 2009 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.