Predictors of Ventricular Arrhythmia Resolution after Continuous Flow-Left Ventricular Assist Device (CF-LVAD) Implantation

Background A significant proportion of patients with history of ventricular arrhythmia experience resolution of ventricular arrhythmia(VAs) after implantation of continuous-flow left ventricular assist devices (CF-LVADs). Factors associated with resolution of these VAs remain unexplored. Objective Identify factors associated with resolution of ventricular arrhythmia after CF-LVAD implantation. Methods A single center retrospective review of patients undergoing CF-LVAD implantation between 2000 and 2015 was done to identify patients with documented history of at least one episode of VT, VF or VT storm preoperatively. Patient characteristics, operative variables and outcomes including development of arrhythmia were assessed. Results 192 patients(82 females (42.71%); 46 patients with age >65 (23.96%)) with previously documented ventricular arrhythmia underwent CF-LVAD implant. 60 (31.3%) patients developed at least 1 episode of ventricular arrhythmia(VAs) after CF-LVAD, whereas 132 (68.7%) experienced no ventricular arrhythmia during the follow-up period. On multivariable analysis, emergent status (OR: 2.97, p=0.040) and need for temporary Mechanical Circulatory Support (2.09, p=0.033) were associated with increased odds of resolution of VAs, whereas previous cardiac surgery (OR:0.47, p=0.038) and use of multiple anti-arrhythmic drugs (OR:0.32, p=0.010) were associated with reduced likelihood of resolution of VAs after CF-LVAD implant. Conclusions Features suggestive of acute hemodynamic failure demonstrated better odds of VA resolution after CF-LVAD implant, whereas structural damage after previous cardiac procedure and severe rhythm disorders requiring aggressive management were associated with reduced likelihood of resolution of VAs after CF-LVAD implant.