Article Dans Une Revue JACC: Clinical Electrophysiology Année : 2019

Early Ventricular Arrhythmias After LVAD Implantation Is the Strongest Predictor of 30-Day Post-Operative Mortality

1 LTSI - Laboratoire Traitement du Signal et de l'Image
2 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
3 Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes]
4 Institut Coeur Poumon [CHU Lille]
5 Service Cardiologie [CHU Toulouse]
6 UB - Université de Bordeaux
7 HUS - Hôpitaux Universitaires de Strasbourg
8 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
9 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
10 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
11 Service de chirurgie thoracique et cardio-vasculaire
12 Department of Anesthesiology and Critical Care Medicine
13 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
14 Cardiac Stimulation and Rhythmology
15 Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
16 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
17 TIMONE - Hôpital de la Timone [CHU - APHM]
18 Hôpital Louis Pradel [CHU - HCL]
19 Service de Cardiologie [CHU Rouen]
20 CHU Caen Normandie - CHU Caen Normandie – Centre Hospitalier Universitaire de Caen Normandie
21 Service de chirurgie cardio-vasculaire et thoracique (CHU Dijon)
22 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
23 CHU Henri Mondor [Créteil]
24 Service de cardiologie
25 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
26 Service Cardiologie Médicale et Médecine Vasculaire [CHU Clermont-Ferrand]
27 CHU Clermont-Ferrand
28 HEGP - Hôpital Européen Georges Pompidou [APHP]
29 Service de cardiologie pédiatrique [CHU Necker]
30 Service de Chirurgie Cardiaque et Transplantations - Hôpital Brabois
31 Service de Cardiologie [CHRU Nancy]
32 Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes]
Mathieu Pernot
Frederic Anselme
Nicolas Lellouche

Résumé

Objectives - This study aimed to evaluate incidence, clinical significance, and predictors of early ventricular arrhythmias (VAs) in left ventricular assist device (LVAD) recipients. Background - LVAD implantation is increasingly used in patients with end-stage heart failure. Early VAs may occur during the 30-day post-operative period, but many questions remain unanswered regarding their incidence and clinical impact. Methods - This observational study was conducted in 19 centers between 2006 and 2016. Early VAs were defined as sustained ventricular tachycardia and/or ventricular fibrillation occurring <30 days post-LVAD implantation and requiring appropriate implantable cardioverter-defibrillator therapy, external electrical shock, or medical therapy. Results - A total of 652 patients (median age: 59.8 years; left ventricular ejection fraction: 20.7 ± 7.4%; HeartMate 2: 72.8%; HeartWare: 19.5%; Jarvik 2000: 7.7%) were included in the analysis. Early VAs occurred in 162 patients (24.8%), most frequently during the first week after LVAD implantation. Multivariable analysis identified history of VAs prior to LVAD and any combined surgery with LVAD as 2 predictors of early VAs. The occurrence of early VAs with electrical storm was the strongest predictor of 30-day post-operative mortality, associated with a 7-fold increase of 30-day mortality. However, in patients discharged alive from hospital, occurrence of early VAs did not influence long-term survival. Conclusions - Early VAs are common after LVAD implantation and increase 30-day post-operative mortality, without affecting long-term survival. Further studies will be needed to analyze whether pre- or pre-operative ablation of VAs may improve post-operative outcomes. (Determination of Risk Factors of Ventricular Arrhythmias After Implantation of Continuous Flow Left Ventricular Assist Device With Continuous Flow Left Ventricular Assist Device [ASSIST-ICD]; NCT02873169).

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hal-02270243 , version 1 (20-12-2021)

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Vincent Galand, Erwan Flécher, Vincent Auffret, Camille Pichard, Stéphane Boulé, et al.. Early Ventricular Arrhythmias After LVAD Implantation Is the Strongest Predictor of 30-Day Post-Operative Mortality. JACC: Clinical Electrophysiology, 2019, 5 (8), pp.944-954. ⟨10.1016/j.jacep.2019.05.025⟩. ⟨hal-02270243⟩
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