Incidence, Predictors, and Significance of Ventricular Arrhythmias in Patients With Continuous-Flow Left Ventricular Assist Devices A 15-Year Institutional Experience
Incidence, Predictors, and Significance of Ventricular Arrhythmias in Patients With Continuous-Flow Left Ventricular Assist Devices A 15-Year Institutional Experience
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DOI：
10.1016/j.jacep.2017.11.001
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发表时间：
2018-02-01
影响因子：
7
通讯作者：
Mathuria, Nilesh
中科院分区：
文献类型：
--
作者：
Greet, Brian D.;Pujara, Deep;Mathuria, Nilesh
本研究的目的是评估接受连续流左心室辅助装置（CFLVAD）的患者中植入前、早期和晚期室性心律失常（VA）的发生率、预测因素和相关死亡率。关于其对当代CFLVADs.METHODS预后影响的数据有限，我们进行了一项回顾性研究，以确定2000年至2015年期间接受CFLVAD植入术的患者，随访2年。分析所有VA，定义为室颤、持续>30 s的室性心动过速或需要除颤的室性心律。植入后30天内发生的VA定义为早期。记录的结果包括死亡和接受心脏transplant.Results共517例患者纳入分析。与晚期或无VA的患者相比，早期VA与生存率显著降低相关（风险比：1.83; 95%置信区间：1.28 - 2.61; p = 0.001）。独立预测早期VA的植入前变量包括既往心脏手术（比值比：1.90; 95%置信区间：1.09 - 3.32; p = 0.023）和CFLVAD前室性心动过速风暴（比值比：3.15; 95%置信区间：1.49 - 6.69; p = 0.003）。2000 - 2007年早期VA的发生率高达47%，而2008 - 2015年最高发生率<22%。结论CFLVAD植入后30 d内VA与死亡风险增加相关。早期VA的预测因素包括既往心脏手术和CFLVAD前室性心动过速风暴。时间趋势显示，从2000年到2015年，VA有所下降。CFLVAD植入后短期内减少心律失常负担的策略需要进一步研究。(c)2018年由美国心脏病学会基金会。
OBJECTIVES The aim of this study was to evaluate the incidence, predictors, and associated mortality of pre-implantation, early, and late ventricular arrhythmias (VAs) in patients receiving continuous-flow left ventricular assist devices (CFLVADs).BACKGROUND VAs are common both pre- and post-implantation of left ventricular assist devices. Limited data exist on their prognostic impact in contemporary CFLVADs.METHODS A retrospective review was performed to identify patients who underwent CFLVAD implantation between 2000 and 2015 with 2 years of follow-up. All VAs, defined as ventricular fibrillation, ventricular tachycardia lasting >30 s, or a ventricular rhythm requiring defibrillation, were analyzed. VAs occurring within 30 days of implantation were defined as early. Recorded outcomes included death and receipt of cardiac transplant.RESULTS A total of 517 patients were included for analysis. Early VAs were associated with a significant reduction in survival (hazard ratio: 1.83; 95% confidence interval: 1.28 to 2.61; p = 0.001) compared with patients with late or no VAs. Pre-implantation variables independently predictive of early VAs included prior cardiac surgery (odds ratio: 1.90; 95% confidence interval: 1.09 to 3.32; p = 0.023) and pre-CFLVAD ventricular tachycardia storm (odds ratio: 3.15; 95% confidence interval: 1.49 to 6.69; p = 0.003). The incidence of early VAs from 2000 to 2007 was as high as 47%, whereas the highest incidence from 2008 to 2015 was < 22%.CONCLUSIONS VAs within 30 days after CFLVAD implantation are associated with an increased risk for death. Predictors of early VAs include prior cardiac surgery and pre-CFLVAD ventricular tachycardia storm. Temporal trends have shown a decrease in VA from 2000 to 2015. Strategies to reduce arrhythmia burden shortly after CFLVAD implantation warrant further investigation. (c) 2018 by the American College of Cardiology Foundation.