Atrial Tachyarrhythmias Among Patients With Left Ventricular Assist Devices: Prevalence, Clinical Outcomes, and Impact of Rhythm Control Strategies.

ABSTRACT

OBJECTIVES: This study sought to describe the burden of atrial fibrillation (AF)/atrial flutter (AFL) in patients with left ventricular assist devices (LVAD) and to evaluate the impact of rhythm control strategies. BACKGROUND: AF and AFL among patients with LVADs are poorly characterized. METHODS: Retrospective multivariable survival analysis of all LVAD recipients at the Cleveland Clinic from January 1, 2004 to June 30, 2016 examining the association of death, thromboembolism, and major bleeding with AF/AFL and exposure to rhythm control measures. RESULTS: Among 418 patients (median age 58 [interquartile range 50 to 67] years, 80% male) with median follow-up of 445 (interquartile range 165 to 936) days, AF (n = 287 of 418, 69%) and AFL (n = 61 of 418, 15%) were highly prevalent. Patients with AF/AFL (n = 302 of 418, 72%) and without AF/AFL (n = 116 of 418, 28%) had similar mortality (39% vs. 38%; p = 0.88) and major bleeding (46% vs. 49%; p = 0.53); AF/AFL patients had fewer thromboembolic events (13% vs. 23%; p < 0.01). Paroxysmal or persistent AF/AFL was present in 238 patients (57%), and rhythm control exposure (n = 166, 70%) was not associated with decreased mortality (39% vs. 43%; p = 0.57), thromboembolism (13% vs. 17%; p = 0.41), or bleeding (49% vs. 39%; p = 0.16). In the multivariable survival analysis only prior valve surgery (hazard ratio 2.0; 95% confidence interval 1.3 to 3.0; p = 0.002) was associated with increased hazard; AF/AFL had no association with risk of death, thromboembolism, or bleeding. CONCLUSIONS: Though highly prevalent among LVAD patients, AF/AFL was not associated with increased mortality, thromboembolism, or bleeding, and among paroxysmal/persistent AF patients, rhythm control measures were not associated with improved outcomes.