Atrial arrhythmias in patients with left ventricular assist devices

Abstract

Purpose of review-Atrial arrhythmias commonly occur in patients with advanced heart failure with reduced ejection fraction (HFrEF) who require left ventricular assist devices (LVADs) implantation. This review summarizes the current literature regarding the incidence, prevalence, and predictors of atrial arrhythmias in LVAD patients and its impact on the clinical outcomes. Moreover, we review the mechanisms and management strategies of atrial arrhythmias in this population.Recent findings-Atrial arrhythmias including atrial fibrillation, atrial flutter, and atrial tachycardia are highly prevalent in patients with advanced HFrEF before or after the LVAD implantation. Atrial arrhythmias have a significant impact on overall clinical outcome including survival, heart failure hospitalization, quality of life, thromboembolic events and resource utilization. Atrial fibrillation and other atrial arrhythmias frequently coexist in this population. In patients with atrial arrhythmias and LVAD, anticoagulation and cardiovascular implantable electronic devices should be closely monitored and managed to prevent thromboembolic events or inappropriate shocks. Rhythm and rate control strategies are comparable regarding overall clinical outcomes in this population. LVADs induce favorable atrial remodeling in patients with HFrEF.Summary-Atrial arrhythmias are highly common in LVAD patients and have significant impact on overall clinical outcomes. Further studies are needed to determine optimal management and prevention of atrial arrhythmias in LVAD population.

Catheter ablation for atrial fibrillation in left ventricular assist device

“…[ 4 ] The combination of beta blockers and digoxin is typically approved for the management of AF. [ 9 ] The efficacy of rhythm control medication is more limited. Several reports have used amiodarone or dofetilide to control AF in LVAD patients.…”

“…Several reports have used amiodarone or dofetilide to control AF in LVAD patients. [ 9 ] In hemodynamically unstable AF, other measures should be taken with caution, but there is a paucity of data available, and RFCA needs to be further studied. [ 3 , 10 , 11 ] Our case is significant in that it reports a successful case of RFCA in controlling medically refractory AF.…”

“…Furthermore, we should consider applying RFCA as early first-line treatment in LVAD patients for both symptomatic and clinical improvement, due to side effects of the rate and rhythm controlling drugs. [3,[8][9][10] The major limitation to this study is the practicality in identifying the timing of intervention. Atrial arrhythmia commonly occurs concurrently in patients with heart failure and oftentimes antiarrhythmic drugs are used as first-line treatment.…”

Advancements in left ventricular assist devices to prevent pump thrombosis and blood coagulopathy

“…Despite advances in the LVAD field and their great benefit, their use is associated with complications, for example, pump thrombosis, stroke, bleeding, infection, right heart failure, aortic insufficiency and arrhythmias (Cook et al, 2017; Han et al, 2018; Kilic et al, 2015; Ozcan & Deshmukh, 2020). Figure 2 shows the LVAD‐related complications and their incidence rates.…”

“…LVAD‐related complications and their incidence rates. Arrhythmias (Ozcan & Deshmukh, 2020), right heart failure (Han et al, 2018; Kilic et al, 2015), gastrointestinal bleeding (Goldstein et al, 2015; Stulak et al, 2014), stroke (Han et al, 2018; Rogers et al, 2017), pump thrombosis (Cook et al, 2017), driveline infections (Rogers et al, 2017). LVAD, left ventricular assist device…”