Predictors and Clinical Impact of Late Ventricular Arrhythmias in Patients With Continuous-Flow Left Ventricular Assist Devices - Université de Montpellier Accéder directement au contenu
Article Dans Une Revue JACC: Clinical Electrophysiology Année : 2018

Predictors and Clinical Impact of Late Ventricular Arrhythmias in Patients With Continuous-Flow Left Ventricular Assist Devices

Stéphane Boulé
  • Fonction : Auteur
P Mondoly
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Frédéric Sacher
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Karine Nubret
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M Kindo
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Thomas Cardi
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Magali Michel
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Pascal Defaye
Constance Verdonk
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Walid Ghodbane
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Edeline Pelcé
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Pierre-Yves Litzer
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Gerard Babatasi
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Annette Belin
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Marie Bielefeld
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Costin Radu
  • Fonction : Auteur
Bertrand Pierre
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Thierry Bourguignon
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Romain Eschalier
Nicolas d'Ostrevy
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  • PersonId : 1345629
  • IdHAL : ndostrevy
Marie-Cécile Bories
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Résumé

Objectives - This study aimed to evaluate the incidence, clinical impact, and predictors of late ventricular arrhythmias (VAs) in left ventricular assist device (LVAD) recipients aiming to clarify implantable cardioverter-defibrillator (ICD) indications. Background - The arrhythmic risk and need for ICD in patients implanted with an LVAD are not very well known. Methods - This observational study was conducted in 19 centers between 2006 and 2016. Late VAs were defined as sustained ventricular tachycardia or fibrillation occurring >30 days post-LVAD implantation, without acute reversible cause and requiring appropriate ICD therapy, external electrical shock, or medical therapy. Results - Among 659 LVAD recipients, 494 (median 58.9 years of age; mean left ventricular ejection fraction 20.7 ± 7.4%; 73.1% HeartMate II, 18.6% HeartWare, 8.3% Jarvik 2000) were discharged alive from hospital and included in the final analysis. Late VAs occurred in 133 (26.9%) patients. Multivariable analysis identified 6 independent predictors of late VAs: VAs before LVAD implantation, atrial fibrillation before LVAD implantation, idiopathic etiology of the cardiomyopathy, heart failure duration >12 months, early VAs (<30 days post-LVAD), and no angiotensin-converting enzyme inhibitors during follow-up. The "VT-LVAD score" was created, identifying 4 risk groups: low (score 0 to 1), intermediate (score 2 to 4), high (score 5 to 6), and very high (score 7 to 10). The rates of VAs at 1 year were 0.0%, 8.0%, 31.0% and 55.0%, respectively. Conclusions - Late VAs are common after LVAD implantation. The VT-LVAD score may help to identify patients at risk of late VAs and guide ICD indications in previously nonimplanted patients. (Determination of Risk Factors of Ventricular Arrhythmias [VAs] after implantation of continuous flow left ventricular assist device with continuous flow left ventricular assist device [CF-LVAD] [ASSIST-ICD]; NCT02873169).
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hal-01879131 , version 1 (30-04-2020)

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Vincent Galand, Erwan Flecher, Vincent Auffret, Stéphane Boulé, André Vincentelli, et al.. Predictors and Clinical Impact of Late Ventricular Arrhythmias in Patients With Continuous-Flow Left Ventricular Assist Devices. JACC: Clinical Electrophysiology, 2018, 4 (9), pp.1166 - 1175. ⟨10.1016/j.jacep.2018.05.006⟩. ⟨hal-01879131⟩
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