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

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.

Authors+Show Affiliations

Division of Cardiology, Hartford Hospital, Hartford, CT, USA. Drop2ash@gmail.com. Department of Medicine, University of Connecticut, Farmington, CT, USA. Drop2ash@gmail.com.Department of Medicine, University of Connecticut, Farmington, CT, USA.Department of Research Administration, Hartford HealthCare, Hartford, CT, USA.Division of Cardiology, Hartford Hospital, Hartford, CT, USA. University of Connecticut School of Medicine, Farmington, CT, USA.Division of Cardiology, Hartford Hospital, Hartford, CT, USA. University of Connecticut School of Medicine, Farmington, CT, USA.Division of Cardiology, Hartford Hospital, Hartford, CT, USA. University of Connecticut School of Medicine, Farmington, CT, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31506872

Citation

Kumar, Aswini, et al. "ICD Shocks in LVAD Patients Are Not Associated With Increased Subsequent Mortality Risk." Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing, 2019.
Kumar A, Tandon V, O'Sullivan DM, et al. ICD shocks in LVAD patients are not associated with increased subsequent mortality risk. J Interv Card Electrophysiol. 2019.
Kumar, A., Tandon, V., O'Sullivan, D. M., Cronin, E., Gluck, J., & Kluger, J. (2019). ICD shocks in LVAD patients are not associated with increased subsequent mortality risk. Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing, doi:10.1007/s10840-019-00619-7.
Kumar A, et al. ICD Shocks in LVAD Patients Are Not Associated With Increased Subsequent Mortality Risk. J Interv Card Electrophysiol. 2019 Sep 10; PubMed PMID: 31506872.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - ICD shocks in LVAD patients are not associated with increased subsequent mortality risk. AU - Kumar,Aswini, AU - Tandon,Varun, AU - O'Sullivan,David M, AU - Cronin,Edmond, AU - Gluck,Jason, AU - Kluger,Jeffrey, Y1 - 2019/09/10/ PY - 2019/05/31/received PY - 2019/08/27/accepted PY - 2019/9/12/entrez KW - ICD shocks KW - LVAD KW - Mortality KW - Symptoms KW - Ventricular arrhythmia JF - Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing JO - J Interv Card Electrophysiol N2 - 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. SN - 1572-8595 UR - https://www.unboundmedicine.com/medline/citation/31506872/ICD_shocks_in_LVAD_patients_are_not_associated_with_increased_subsequent_mortality_risk L2 - https://doi.org/10.1007/s10840-019-00619-7 DB - PRIME DP - Unbound Medicine ER -