Arrhythmia Burden from Implantable Device Interrogation during Long-Term Follow-Up in LVAD Patients

Purpose The burden of atrial arrhythmias (AA) and ventricular tachycardia/fibrillation (VT/VF) during long-term continuous-flow (CF) LVAD support is not well described. Methods Our Arrhythmia Database included all implantable cardioverter-defibrillator interrogations completed from September 2015 to August 2019 for 101 consecutive CF-LVAD patients at a single center. Endpoints included first occurrence of any arrhythmia, AA, and VT/VF. Results Patients (mean age at LVAD implant 59±12 years, 83% male, 51% with ischemic cardiomyopathy, 60% with history of AA before LVAD implant, and 75% with history of VT/VF before LVAD implant) were supported by an LVAD for a median of 2.1 years before entering the Arrhythmia Database. Subsequent follow-up in the Database extended over >2 years. At 2.5 years from Arrhythmia Database entry (median of 4.5 years from LVAD implant), the cumulative rate of any arrhythmia was 74%, the rate of AA was 66%, and the rate of VT/VF was 47% (Figure). Conclusion Both atrial and ventricular arrhythmias remain common during long-term LVAD support (median >4 years). Our findings support the role of generator replacement of implantable devices for continued detection and treatment of arrhythmic events in LVAD patients.