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

被引：71

作者：

Galand, Vincent ^{[1
,2
,3
]}

Flecher, Erwan ^{[2
,4
]}

Auffret, Vincent ^{[1
,2
,3
]}

Boule, Stephane ^{[5
]}

Vincentelli, Andre ^{[5
]}

Dambrin, Camille ^{[6
]}

Mondoly, Pierre ^{[6
]}

Sacher, Frederic ^{[7
]}

Nubret, Karine ^{[7
]}

Kindo, Michel ^{[8
]}

Cardi, Thomas ^{[8
]}

Gaudard, Philippe ^{[9
]}

Rouviere, Philippe ^{[9
]}

Michel, Magali ^{[10
,11
]}

Gourraud, Jean-Baptiste ^{[10
,11
]}

Defaye, Pascal ^{[12
]}

Chavanon, Olivier ^{[12
]}

Verdonk, Constance ^{[13
]}

Ghodbane, Walid ^{[13
]}

Pelce, Edeline ^{[14
]}

Gariboldi, Vlad ^{[14
]}

Pozzi, Matteo ^{[15
]}

Obadia, Jean-Francois ^{[15
]}

Litzler, Pierre-Yves ^{[16
]}

Anselme, Frederic ^{[16
]}

Babatasi, Gerard ^{[17
]}

Belin, Annette ^{[17
]}

Garnier, Fabien ^{[18
]}

Bielefeld, Marie ^{[18
]}

Hamon, David ^{[19
]}

Radu, Costin ^{[19
]}

Pierre, Bertrand ^{[20
]}

Bourguignon, Thierry ^{[20
]}

Eschalier, Romain ^{[21
]}

D'Ostrevy, Nicolas ^{[21
]}

Bories, Marie-Cecile ^{[1
]}

Marijon, Eloi ^{[22
]}

Vanhuyse, Fabrice ^{[23
]}

Blangy, Hugues ^{[23
]}

Verhoye, Jean-Philippe ^{[4
]}

Leclercq, Christophe ^{[1
,2
,3
]}

Martins, Raphael P. ^{[1
,2
,3
]}

机构：

[1] CHU Rennes, Serv Cardiol & Malad Vasc, 2 Rue Henri Le Guilloux, F-35000 Rennes, France

[2] Univ Rennes 1, Rennes, France

[3] INSERM, U11099, Rennes, France

[4] Ser Chirurg Cardiaque & Thorac, Rennes, France

[5] CHU Lille, Dept Cardiac Surg, Dept Cardiol, Cardiac Intens Care Unit,Inst Coeur Poumons, Lille, France

[6] CHU Toulouse, Serv Cardiol, Toulouse, France

[7] Univ Bordeaux II, Senrice Cardiol, Hop Cardiol Haut Leveque, Bordeaux, France

[8] Hop Univ Strasbourg, Dept Chirurg Cardiovasc, Strasbourg, France

[9] CHRU Montpellier, Dept Cardiac Surg Anesthesiol & Crit Care Med, Arnaud de Villeneuve Hosp, Montpellier, France

[10] CHU Nantes, Dept Cardiol, Nantes, France

[11] CHU Nantes, Heart Transplantat Unit, Nantes, France

[12] CHU Michallon, Dept Cardiol & Cardiovasc Surg, Grenoble, France

[13] Hop Xavier Bichat, Dept Cardiol & Cardiac Surg, Paris, France

[14] La Timone Hosp, Dept Cardiac Surg, Marseille, France

[15] Louis Pradel Cardiol Hosp, Dept Cardiac Surg, Lyon, France

[16] Hop Charles Nicolle, Dept Cardiol & Cardiovasc Surg, Rouen, France

[17] Univ Caen, Univ Hosp Caen, Dept Cardiol & Cardiac Surg, Caen, France

[18] Univ Hosp Dijon Bourgogne, Dept Cardiol & Cardiac Surg, Dijon, France

[19] CHU Henri Mondor, AP HP, Dept Cardiol & Cardiac Surg, Creteil, France

[20] Tours Univ Hosp, Dept Cardiol & Cardiac Surg, Tours, France

[21] CHU Clermont Ferrand, Cardiol Dept, Clermont Ferrand, France

[22] Hop Europeen Georges Pompidou, Cardiol Dept, Paris, France

[23] CHU Nancy, Dept Cardiol & Cardiac Surg, Hop Brabois, Nancy, France

来源：

JACC-CLINICAL ELECTROPHYSIOLOGY | 2018年 / 4卷 / 09期

关键词：

implantable cardioverter-defibrillator; left ventricular assist device; ventricular arrhythmias; IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR; MECHANICAL CIRCULATORY SUPPORT; HEART-FAILURE; MANAGEMENT; MORTALITY; THERAPY; TACHYARRHYTHMIAS; GUIDELINES; ABLATION; RISK;

D O I：

10.1016/j.jacep.2018.05.006

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 (C) 2018 by the American College of Cardiology Foundation.

引用

页码：1166 / 1175

页数：10

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