Atrial Fibrillation Is Associated with Recurrent Ventricular Arrhythmias After LVAD Implant: Incidence and Impact in a Consecutive Series

Hickey, Kathleen T.; Colombo, P.C.; Naka, Yoshifumi; Garan, A.R.; Yuzefpolskaya, M.; Garan, Hasan; Wan, Elaine; Sciacca, Robert R.; Goldenthal, Isaac; Biviano, Angelo

doi:10.1007/s12265-019-09914-0

Cited by 6 publications

(3 citation statements)

References 20 publications

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“…Though these series control for confounding patient factors, it is unclear whether persistent atrial fibrillation identifies patients with more comorbidities or whether persistent atrial arrhythmias independently impact outcomes. The latter possibility is suggested by evidence that atrial fibrillation is associated with right ventricular failure and ventricular arrhythmias after LVAD [10,15,[25][26][27]. LVAD patients with atrial fibrillation also have a higher risk of ventricular arrhythmia.…”

Section: Impact Of Atrial Arrhythmias On Clinical Outcomes In Left Ventricular Assist Devices Patientsmentioning

confidence: 99%

Atrial arrhythmias in patients with left ventricular assist devices

Özcan¹,

Deshmukh

2020

Current Opinion in Cardiology

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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.

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Section: Impact Of Atrial Arrhythmias On Clinical Outcomes In Left Ventricular Assist Devices Patientsmentioning

confidence: 99%

Atrial arrhythmias in patients with left ventricular assist devices

Özcan¹,

Deshmukh

2020

Current Opinion in Cardiology

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“…[25] X Papathanisious et al 2019[26] X X XHickey et al 2020 [27] X X Deshmukh et al 2017 [17] X X Brenyo et al 2012) [28] X X Iwasaki et al 2020 [29] X X X Deshmukh et al 2018 [30] X X X X Hickey et al 2016 [16] X X Noll et al 2019 [31] X X X X Gonuguntla et al 2020 [32] X X Imamura et al 2019 [33] X X X X Joy et al 2016 [34] X X Morgan et al 2016 [35] X X X Xuereb et al 2016 [36] X X X X X Hui et al 2018 [38] X Hawkins et al 2018 [39] X X X Xia et al 2016 [41] X X X Kurihara et al 2018 [43] X X Enriquez et al 2014 [14] X X X X Nassif et al 2016 [44] X X X Izzy et al 2018 [45] X X Stulak et al 2013 [15] X X X Morris et al 2015 [47] X X Blumer et al 2020 [22]…”

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confidence: 99%

Atrial fibrillation in mechanical circulatory support patients

Obeid¹,

Yaligar²,

McLarty³

et al. 2022

Vessel Plus

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Atrial fibrillation (AF) is known to be one of the most common arrhythmias noted in cardiac procedures and is frequently associated with heart failure. As frequent interventions for patients with heart failure involve implantation of mechanical circulatory assist devices (e.g., left ventricular assist devices), it is timely to review the role this arrhythmia has on adverse clinical outcomes. A comprehensive literature search was conducted for PubMed. Relevant medical subject heading (MeSH) terms used in the initial literature search include “Heart-Assist Devices”, “Extracorporeal Membrane Oxygenation”, “Atrial Fibrillation”, “Heart Failure”, “Mortality”, “Hospital Readmission”, “stroke”, “Postoperative Complications”. In this review, the relevant literature was highlighted to identify the incidence, clinical impacts, and management of AF surrounding mechanical circulatory support implantation. The incidence of AF in this mechanical circulatory support device population was similar to that of patients with other cardiac procedures (10%-40%). Moreover, in most studies, preoperative AF was not significantly associated with adverse outcomes. In contrast, however, it appears that postoperative atrial fibrillation may predispose patients to increased risk for thromboembolic events and adverse long-term outcomes.

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“… 5 As a supraventricular tachyarrhythmia, AF has been associated with degraded health‐related quality of life, diminished exercise capacity, ischemic cerebral stroke or extracranial systemic thromboembolism, impaired cognition or dementia, chronic kidney disease, acute myocardial infarction, tachycardia‐induced cardiomyopathy, congestive heart failure, sinoatrial node dysfunction, ventricular arrhythmias, and sudden cardiac death. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 In fact, AF confers a 4‐ to 5‐fold increased risk of ischemic stroke, accounting for 15% of all strokes, a 5‐fold increased risk of heart failure, and a 2‐fold increased risk of demise. 20 Therefore, AF has become a major socioeconomic burden, given that existing treatment regimens are limited in efficacy and are seldom curative.…”

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confidence: 99%

PRRX1 Loss‐of‐Function Mutations Underlying Familial Atrial Fibrillation

Guo

Qiu

Wang

et al. 2021

JAHA

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Background Atrial fibrillation (AF) is the most common form of clinical cardiac dysrhythmia responsible for thromboembolic cerebral stroke, congestive heart failure, and death. Aggregating evidence highlights the strong genetic basis of AF. Nevertheless, AF is of pronounced genetic heterogeneity, and in an overwhelming majority of patients, the genetic determinants underpinning AF remain elusive. Methods and Results By genome‐wide screening with polymorphic microsatellite markers and linkage analysis in a 4‐generation Chinese family affected with autosomal‐dominant AF, a novel locus for AF was mapped to chromosome 1q24.2–q25.1, a 3.20‐cM (≈4.19 Mbp) interval between markers D1S2851 and D1S218, with the greatest 2‐point logarithm of odds score of 4.8165 for the marker D1S452 at recombination fraction=0.00. Whole‐exome sequencing and bioinformatics analyses showed that within the mapping region, only the mutation in the paired related homeobox 1 ( PRRX1 ) gene, NM_022716.4:c.319C>T;(p.Gln107*), cosegregated with AF in the family. In addition, sequencing analyses of PRRX1 in another cohort of 225 unrelated patients with AF revealed a new mutation, NM_022716.4:c.437G>T; (p.Arg146Ile), in a patient. The 2 mutations were absent in 908 control subjects. Biological analyses in HeLa cells demonstrated that the 2 mutants had significantly diminished transactivation on the target genes ISL1 and SHOX2 and markedly decreased ability to bind the promoters of ISL1 and SHOX2 (2 genes causally linked to AF), although with normal intracellular distribution. Conclusions This study first indicates that PRRX1 loss‐of‐function mutations predispose to AF, which provides novel insight into the molecular pathogenesis underpinning AF, implying potential implications for precisive prophylaxis and management of AF.

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Atrial Fibrillation Is Associated with Recurrent Ventricular Arrhythmias After LVAD Implant: Incidence and Impact in a Consecutive Series

Cited by 6 publications

References 20 publications

Atrial arrhythmias in patients with left ventricular assist devices

Atrial arrhythmias in patients with left ventricular assist devices

Atrial fibrillation in mechanical circulatory support patients

PRRX1 Loss‐of‐Function Mutations Underlying Familial Atrial Fibrillation

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