Effect of Continued Cardiac Resynchronization Therapy on Ventricular Arrhythmias After Left Ventricular Assist Device Implantation

Schleifer, J. William; Mookadam, Farouk; Kransdorf, E.; Nanda, Udai; Adams, Jonathon C.; Cha, Stephen; Pajaro, Octavio E.; Steidley, D. Eric; Scott, Robert L.; Carvajal, Tomas; Saadiq, Rayya A.; Srivathsan, Komandoor

doi:10.1016/j.amjcard.2016.05.050

Cited by 37 publications

(22 citation statements)

References 17 publications

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“…However, in contrast to the prior study from Schleifer et al,14 we did not observe any significant reduction in the incidence of VA or ICD shocks in the CRT group. Antiarrhythmic drug and β‐blocker use during CF‐LVAD support were similar in both groups.…”

Section: Discussioncontrasting

confidence: 99%

“…In contrast, our study results are strengthened significantly by our large sample size and multicenter experience, allowing robust Cox regression analyses exploring the independent association of CRT with survival. Our study results concur with the prior studies13, 14 in that concomitant CRT following CF‐LVAD did not offer any significant survival advantage. In fact, we noted a trend towards reduced survival in the CRT‐D group at 1‐year follow‐up compared with the ICD group, suggesting early harm.…”

Section: Discussionsupporting

confidence: 92%

“…However, the benefit of CRT on clinical outcomes following CF‐LVAD implantation remains unclear. Available data, from 2 observational studies evaluating this question show possible arrhythmic benefits but no overall survival benefit for CRT in a CF‐LVAD population 13, 14. These single‐center studies, however, were limited by very small sample size.…”

mentioning

confidence: 99%

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Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Gopinathannair

Roukoz

Bhan

et al. 2018

JAHA

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BackgroundMany patients with heart failure continue cardiac resynchronization therapy (CRT) after continuous flow left ventricular assist device (CF‐LVAD) implant. We report the first multicenter study to assess the impact of CRT on clinical outcomes in CF‐LVAD patients.Methods and ResultsAnalysis was performed on 488 patients (58±13 years, 81% male) with an implantable cardioverter defibrillator (ICD) (n=223) or CRT‐D (n=265) who underwent CF‐LVAD implantation at 5 centers from 2007 to 2015. Effects of CRT on mortality, hospitalizations, and ventricular arrhythmia incidence were compared against CF‐LVAD patients with an ICD alone. Baseline differences were noted between the 2 groups in age (60±12 versus 55±14, P<0.001) and QRS duration (159±29 versus 126±34, P=0.001). Median biventricular pacing in the CRT group was 96%. During a median follow‐up of 478 days, Kaplan–Meier analysis showed no difference in survival between groups (log rank P=0.28). Multivariate Cox regression demonstrated no survival benefit with type of device (ICD versus CRT‐D; P=0.16), whereas use of amiodarone was associated with increased mortality (hazard ratio 1.77, 95% confidence interval 1.1–2.8, P=0.01). No differences were noted between CRT and ICD groups in all‐cause (P=0.06) and heart failure (P=0.9) hospitalizations, ventricular arrhythmia incidence (43% versus 39%, P=0.3), or ICD shocks (35% versus 29%, P=0.2). During follow‐up, 69 (26%) patients underwent pulse generator replacement in the CRT‐D group compared with 36 (15.5%) in the ICD group (P=0.003).ConclusionsIn this large, multicenter CF‐LVAD cohort, continued CRT was not associated with improved survival, hospitalizations, incidence of ventricular arrhythmia and ICD therapies, and was related to a significantly higher number of pulse generator changes.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 92%

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Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Gopinathannair

Roukoz

Bhan

et al. 2018

JAHA

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“…Additionally, the utility of CRT in patients with LVADs is relatively unknown and in this study almost all did not have the coronary sinus lead active following implantation. In a study by Schleifer et al, patients with CRT activated following implantation had a significant reduction in ICD shocks and VA burden, 17 while Gopinathannair et al found the opposite. 18 Further research is needed to understand the mechanics surrounding CRT in patients with LVADs.…”

Section: Discussionmentioning

confidence: 99%

Effect of Ventricular Arrhythmia Ablation in Patients With Heart Mate II Left Ventricular Assist Devices: An Evaluation of Ablation Therapy

Snipelisky

Reddy

Manocha

et al. 2016

Cardiovasc electrophysiol

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“…A single retrospective study suggested that the presence of a CRT‐D as compared with an ICD did not affect mortality, hospitalization rates, or ICD shocks . However, a single‐center prospective evaluation of patients with CRT inactivated in a nonrandomized fashion following LVAD implantation did demonstrate decreased incidence of ICD shocks in patients with CRT active . An antiarrhythmic effect of CRT, at least in CRT responders, has been demonstrated in patients without LVAD .…”

Section: Discussionmentioning

confidence: 99%

Prospective Randomized Evaluation of Implantable Cardioverter‐Defibrillator Programming in Patients With a Left Ventricular Assist Device

Richardson¹,

Hale²,

Arteaga

et al. 2018

JAHA

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BackgroundVentricular arrhythmias are common in patients with left ventricular assist devices (LVADs) but are often hemodynamically tolerated. Optimal implantable cardioverter defibrillator (ICD) tachy‐programming strategies in patients with LVAD have not been determined. We sought to determine if an ultra‐conservative ICD programming strategy in patients with LVAD affects ICD shocks.Methods and ResultsAdult patients with an existing ICD undergoing continuous flow LVAD implantation were randomized to standard ICD programming by their treating physician or an ultra‐conservative ICD programming strategy utilizing maximal allowable intervals to detection in the ventricular fibrillation and ventricular tachycardia zones with use of ATP. Patients with cardiac resynchronization therapy (CRT) devices were also randomized to CRT ON or OFF. Patients were followed a minimum of 6 months. The primary outcome was time to first ICD shock. Among the 83 patients studied, we found no statistically significant difference in time to first ICD shock or total ICD shocks between groups. In the ultra‐conservative group 16% of patients experienced at least one shock compared with 21% in the control group (P=0.66). There was no difference in mortality, arrhythmic hospitalization, or hospitalization for heart failure. In the 41 patients with CRT ICDs fewer shocks were observed with CRT‐ON but this was not statistically significant: 10% of patients with CRT‐ON (n=21) versus 38% with CRT‐OFF (n=20) received shocks (P=0.08).ConclusionsAn ultra‐conservative programming strategy did not reduce ICD shocks. Programming restrictions on ventricular tachycardia and ventricular fibrillation zone therapy should be reconsidered for the LVAD population. The role of CRT in patients with LVAD warrants further investigation.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT01977703.

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Effect of Continued Cardiac Resynchronization Therapy on Ventricular Arrhythmias After Left Ventricular Assist Device Implantation

Cited by 37 publications

References 17 publications

Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Effect of Ventricular Arrhythmia Ablation in Patients With Heart Mate II Left Ventricular Assist Devices: An Evaluation of Ablation Therapy

Prospective Randomized Evaluation of Implantable Cardioverter‐Defibrillator Programming in Patients With a Left Ventricular Assist Device

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