Association of Atrial Fibrillation and Postoperative Right Ventricular Failure after Left Ventricular Assist Device Implantation: Systematic Review and Meta-Analysis

Background Right ventricular failure (RVF) remains a major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation. Atrial fibrillation (AF) is a common arrhythmia in advanced heart failure patients undergoing LVAD implantation. Studies have shown that AF is a predictor for RVF in decompensated heart failure patients. Little is known about the association between AF and risk of developing RVF early after LVAD implantation. Method We performed a comprehensive literature search through March 2019 using MEDLINE, EMBASE, Scopus and the Cochrane Library. Included studies were prospective or retrospective cohort studies that compared the risk of developing postoperative RVF or use of emergent/unplanned right ventricular assist device (RVAD) after LVAD implantation in patients with and without AF. We calculated the pooled odds ratio (OR) with 95% confidence intervals (CI) and I2 statistic using the random-effect model. Results Nine studies were included in the analysis. The pooled prevalence of AF was 31%. Postoperative RVF after LVAD implantation was reported in 6 studies involving 1,575 patients (581 AF, 994 non-AF) and unplanned RVAD implantation was reported in 6 studies involving 2,089 patients (640 AF, 1449 non-AF). The incidence of postoperative RVF was 37% and 32% in patients with and without AF, respectively. The incidence of unplanned RVAD implantation was 15% and 12% in patients with and without AF, respectively. There is a significant association between AF and postoperative RVF (OR=1.29, 95%CI=1.03-1.61: p=0.03) but not between AF and unplanned RVAD implantation (OR=1.29, 95%CI=0.96-1.75: p=0.09) (See Figure 1). Conclusions Our meta-analysis suggests that concomitant AF was common in patients undergoing LVAD implantation. The presence of AF is associated with an increased risk of postoperative RVF but not unplanned RVAD support following LVAD implantation.