Incidence and Outcomes of Postoperative Atrial Fibrillation After Left Ventricular Assist Device

Abstract

This study sought to determine the incidence, predictors, and outcomes of postoperative atrial fibrillation (POAF) in patients undergoing implantation of left ventricular assist devices (LVADs). A retrospective analysis of all patients who underwent LVAD implantation from 2013 to 2014 was conducted. Postoperative AF, survival, and thrombotic complications were evaluated after surgery. A total of 47 patients (mean age, 56.4 ± 12.5 years; 33 male) were included and followed for a median of 331 days. Within 30 days of surgery, 13 (28%) patients developed POAF at mean 7.9 ± 8.5 days. Obstructive lung disease was a predictor of POAF (p = 0.01). Postoperative AF was not associated with increased mortality, length of stay, or thrombotic complication within 30 days. Postoperative AF was predictive of recurrent new AF (24 vs. 5.5%) after 30 days of LVAD implantation. Also, POAF was associated with increased risk of ischemic stroke and device thrombosis during follow-up (p = 0.01). These results show that unlike in other cardiac surgery, POAF does not have a negative impact on early postoperative morbidity or mortality. However, POAF is a predictor for future AF, ischemic stroke, and device thrombosis.

Impact of preoperative atrial fibrillation in patients with left ventricular assist device: A systematic review and meta‐analysis

“…Deshmukh et al later published another retrospective study exclusively on 47 patients who underwent LVAD implantation and developed de novo POAF. 26 This study reported 28% incidence of de novo POAF with a median onset of 6 days after the surgery, which found no significant association between de novo POAF and mortality risk. However, it was a predicting factor for recurrent atrial fibrillation, device thrombosis, and stroke during longterm follow-up.…”

“…Thirty‐seven patients developed de novo POAF which was accounting for 20.7% of patients with no history of AF. Deshmukh et al later published another retrospective study exclusively on 47 patients who underwent LVAD implantation and developed de novo POAF . This study reported 28% incidence of de novo POAF with a median onset of 6 days after the surgery, which found no significant association between de novo POAF and mortality risk.…”

Atrial arrhythmias in patients with left ventricular assist devices

“…The incidence of new onset atrial arrhythmias after LVAD is high in both the early postoperative period and afterward. Atrial fibrillation is documented in about 8% of patients after the first 30 days of LVAD [6,9,10]. Approximately 10-20% of patients develop new onset atrial fibrillation in the year following LVAD implant [5,6,7 ■ ,8].…”

“…It is important to define the clinical characteristic, predictors, and treatment outcome in this population. Recent studies have shown that atrial arrhythmias, particularly atrial fibrillation, are highly prevalent in patients with advanced HFrEF before or after the LVAD implantation [1,2 ■■ ,3-6,7 ■ , 8,9]. Atrial arrhythmias have significant clinical and therapeutic implications in this population.…”

Catheter ablation for atrial fibrillation in left ventricular assist device

“…New-onset atrial fibrillation (AF) is prevalent among patients with left ventricular assist device (LVAD) implantation. [ 1 ] Although the clinical impact of atrial arrhythmias (AA) on LVAD recipients is not entirely clear, sustained AAs predispose patients to a risk of right heart failure. [ 2 ] Several studies have shown that AAs in LVAD support are associated with increased readmission and mortality rates.…”