Association Between Early Ventricular Arrhythmias and Mortality in Destination Vs. Bridge Patients on Continuous Flow LVAD Support

Abstract Background: The association between ventricular arrhythmias (VAs) and mortality in patients supported by continuous flow left ventricular assist devices (LVAD) remains controversial. Objective: To evaluate the association between pre-implantation, early (≤30 day) post-implantation VAs and mortality in bridge to transplant (BTT) and destination therapy (DT) LVAD patients, separately. The risk factors for post LVAD VAs were also investigated.Methods: In this observational cohort study, we included 341 patients who received a first time, continuous flow LVAD between January 1st 2010 and July 30th 2018. We used Kaplan Meier curves and multivariable cox regression analyses to study the association between VAs and mortality in the BTT and DT populations.Results: The mean age of the cohort was 58 ± 14 years, with 82% males, 53% had ischemic cardiomyopathy, and 45% were DT. The mean follow-up was 2.2 ± 2.1 years. In both BTT and DT cohorts, pre LVAD VAs were not associated with mortality after LVAD implantation (log-rank p=0.95 and p=0.089, respectively). In the BTT population, early post-LVAD VAs were not statistically associated with increased mortality (log rank p=0.072). In the DT patients, early post LVAD VAs were associated with a 67 % increase in the hazards rate of mortality on LVAD support (HR 1.67 [1.05-2.65], p=0.029). The final model was adjusted for type of cardiomyopathy, INTERMACS profile, glomerular filtration rate, post LVAD atrial fibrillation, age and cerebrovascular events.Conclusion: Early post-LVAD VA is common after LVAD implantation and is an independent predictor of mortality in the DT LVAD population.