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Incidence, predictors, and clinical impact of electrical storm in patients with left ventricular assist devices: New insights from the ASSIST-ICD study

      Background

      Ventricular arrhythmias (VAs) can occur after continuous flow left ventricular assist device (LVAD) implantation as a single arrhythmic event or as electrical storm (ES) with multiple repetitive VA episodes.

      Objective

      We aimed at analyzing the incidence, predictors, and clinical impact of ES in LVAD recipients.

      Methods

      Patients analyzed were those included in the multicenter ASSIST-ICD observational study. ES was consensually defined as occurrence of ≥3 separate episodes of sustained VAs within a 24-hour interval.

      Results

      Of 652 patients with an LVAD, 61 (9%) presented ES during a median follow-up period of 9.1 (interquartile range [IQR] 2.5–22.1) months. The first ES occurred after 17 (IQR 4.0–56.2) days post LVAD implantation, most of them during the first month after the device implantation (63%). The incidence then tended to decrease during the initial years of follow-up and increased again after the third year post LVAD implantation. History of VAs before LVAD implantation and heart failure duration > 84 months were independent predictors of ES. The occurrence of ES was associated with an increased early mortality since 20 patients (33%) died within the first 2 weeks of ES. Twenty-two patients (36.1%) presented at least 1 recurrence of ES, occurring 43.0 (IQR 8.0–69.0) days after the initial ES. Patients experiencing ES had a significantly lower 1-year survival rate than did those free from ES (log-rank, P = .039).

      Conclusion

      There is a significant incidence of ES in patients with an LVAD. The short-term mortality after ES is high, and one-third of patients will die within 15 days. Whether radiofrequency ablation of arrhythmias improves outcomes would require further studies.

      Keywords

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      References

        • Kirklin J.K.
        • Naftel D.C.
        • Kormos R.L.
        • et al.
        Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) analysis of pump thrombosis in the HeartMate II left ventricular assist device.
        J Heart Lung Transplant. 2014; 33: 12-22
        • Garan A.R.
        • Levin A.P.
        • Topkara V.
        • et al.
        Early post-operative ventricular arrhythmias in patients with continuous-flow left ventricular assist devices.
        J Heart Lung Transplant. 2015; 34: 1611-1616
        • Greet B.D.
        • Pujara D.
        • Burkland D.
        • et al.
        Incidence, predictors, and significance of ventricular arrhythmias in patients with continuous-flow left ventricular assist devices: a 15-year institutional experience.
        JACC Clin Electrophysiol. 2017; 4: 257-264
        • Efimova E.
        • Fischer J.
        • Bertagnolli L.
        • et al.
        Predictors of ventricular arrhythmia after left ventricular assist device implantation: a large single-center observational study.
        Heart Rhythm. 2017; 14: 1812-1819
        • Enriquez A.D.
        • Calenda B.
        • Miller M.A.
        • Anyanwu A.C.
        • Pinney S.P.
        The role of implantable cardioverter-defibrillators in patients with continuous flow left ventricular assist devices.
        Circ Arrhythm Electrophysiol. 2013; 6: 668-674
        • Galand V.
        • Flécher E.
        • Auffret V.
        • et al.
        Predictors and clinical impact of late ventricular arrhythmias in patients with continuous-flow left ventricular assist devices.
        JACC Clin Electrophysiol. 2018; 4: 1166-1175
        • Garan A.R.
        • Yuzefpolskaya M.
        • Colombo P.C.
        • et al.
        Ventricular arrhythmias and implantable cardioverter-defibrillator therapy in patients with continuous-flow left ventricular assist devices: need for primary prevention?.
        J Am Coll Cardiol. 2013; 61: 2542-2550
        • Oswald H.
        • Schultz-Wildelau C.
        • Gardiwal A.
        • et al.
        Implantable defibrillator therapy for ventricular tachyarrhythmia in left ventricular assist device patients.
        Eur J Heart Fail. 2010; 12: 593-599
        • Yoruk A.
        • Sherazi S.
        • Massey H.T.
        • et al.
        Predictors and clinical relevance of ventricular tachyarrhythmias in ambulatory patients with a continuous flow left ventricular assist device.
        Heart Rhythm. 2016; 13: 1052-1056
        • Sagone A.
        Electrical storm: incidence, prognosis and therapy.
        J Atr Fibrillation. 2015; 8: 1150
        • Corre J.
        • Picard F.
        • Garcia R.
        • et al.
        Electrical storm in the early phase of HeartMate® II device implantation: incidence, risk factors and prognosis.
        Arch Cardiovasc Dis. 2018; 111: 332-339
        • Sesselberg H.W.
        • Moss A.J.
        • McNitt S.
        • et al.
        Ventricular arrhythmia storms in postinfarction patients with implantable defibrillators for primary prevention indications: a MADIT-II substudy.
        Heart Rhythm. 2007; 4: 1395-1402
        • Exner D.V.
        • Pinski S.L.
        • Wyse D.G.
        • et al.
        Electrical storm presages nonsudden death: the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial.
        Circulation. 2001; 103: 2066-2071
        • Harding J.D.
        • Piacentino III, V.
        • Gaughan J.P.
        • Houser S.R.
        • Margulies K.B.
        Electrophysiological alterations after mechanical circulatory support in patients with advanced cardiac failure.
        Circulation. 2001; 104: 1241-1247
        • Rose E.A.
        • Gelijns A.C.
        • Moskowitz A.J.
        • et al.
        Long-term use of a left ventricular assist device for end-stage heart failure.
        N Engl J Med. 2001; 345: 1435-1443
        • Heerdt P.M.
        • Holmes J.W.
        • Cai B.
        • et al.
        Chronic unloading by left ventricular assist device reverses contractile dysfunction and alters gene expression in end-stage heart failure.
        Circulation. 2000; 102: 2713-2719
        • Guerra F.
        • Shkoza M.
        • Scappini L.
        • Flori M.
        • Capucci A.
        Role of electrical storm as a mortality and morbidity risk factor and its clinical predictors: a meta-analysis.
        Europace. 2014; 16: 347-353
        • Vergara P.
        • Tung R.
        • Vaseghi M.
        • et al.
        Successful ventricular tachycardia ablation in patients with electrical storm reduces recurrences and improves survival.
        Heart Rhythm. 2018; 15: 48-55
        • Guerra F.
        • Flori M.
        • Bonelli P.
        • Patani F.
        • Capucci A.
        Electrical storm and heart failure worsening in implantable cardiac defibrillator patients.
        Europace. 2014; 17: 247-254
        • Sacher F.
        • Reichlin T.
        • Zado E.S.
        • et al.
        Characteristics of ventricular tachycardia ablation in patients with continuous flow left ventricular assist devices.
        Circ Arrhythm Electrophysiol. 2015; 8: 592-597