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

Vincent Galand 1, 2 Erwan Flecher 3, 1 Vincent Auffret 1, 2 Stéphane Boulé André Vincentelli 4 Camille Dambrin 5 P Mondoly Frédéric Sacher 6 Karine Nubret 6 M Kindo Thomas Cardi Philippe Gaudard 7, 8 Philippe Rouvière 9 Magali Michel Jean-Baptiste Gourraud 10 Pascal Defaye 11 Olivier Chavanon 12 Constance Verdonk Walid Ghodbane Edeline Pelcé Vlad Gariboldi 13, 14 Matteo Pozzi 15 Jean-Francois Obadia 16 Pierre-Yves Litzer Frederic Anselme 17 Gerard Babatasi Annette Belin Fabien Garnier 18 Marie Bielefeld David Hamon 19 Costin Radu Bertrand Pierre 20 Thierry Bourguignon Romain Eschalier 21 Nicolas d'Ostrevy 22 Marie-Cécile Bories Eloi Marijon 23 Fabrice Vanhuyse 24 Hugues Blangy 25 Jean-Philippe Verhoye 1, 3 Christophe Leclercq 1, 2 Raphael Martins 1, 2
Abstract : 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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Soumis le : jeudi 30 avril 2020 - 10:05:45
Dernière modification le : vendredi 15 mai 2020 - 12:22:09

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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, Elsevier, 2018, 4 (9), pp.1166 - 1175. ⟨10.1016/j.jacep.2018.05.006⟩. ⟨hal-01879131⟩

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