Impact of Cardiac Resynchronization Therapy on Ventricular Arrhythmias and Survival After Durable Left Ventricular Assist Device Implantation.
Connor P OatesLuke L LawrenceGrace E BighamNamratha S MedaBinaya BasyalSriram D RaoCyrus A HadadiSamer S NajjarManish H ShahFarooq H SheikhPhillip H LamPublished in: ASAIO journal (American Society for Artificial Internal Organs : 1992) (2024)
The impact of cardiac resynchronization therapy (CRT) in patients receiving durable left ventricular assist device (LVAD) implantation remains unclear and there is no consensus regarding postoperative management. We sought to determine the impact of postoperative management of CRT on clinical outcomes following LVAD implantation. A total of 789 patients underwent LVAD implantation at our institution from 2007 to 2022 including 195 patients (24.7%) with preoperative CRT. Patients with preoperative CRT were significantly older and more frequently received an LVAD as destination therapy compared to patients without preoperative CRT. After LVAD implantation, 85 patients had CRT programmed "off" and 74 patients had CRT programmed "on." The risk of mortality was significantly increased amongst patients with preoperative CRT that was turned "on" following LVAD implantation compared to patients with preoperative CRT turned "off" following implant (subdistribution hazard ratio [sdHR] = 1.54; 1.06-2.37 95% confidence interval [CI]; p = 0.036). There was no significant difference between incidence of ventricular arrhythmias in patients with and without postoperative CRT "on" (35.1% vs. 48.2%; p = 0.095). Additional clinical trials are warranted to determine the best CRT programming strategy following LVAD implantation.
Keyphrases
- cardiac resynchronization therapy
- left ventricular assist device
- left ventricular
- heart failure
- end stage renal disease
- patients undergoing
- ejection fraction
- chronic kidney disease
- peritoneal dialysis
- randomized controlled trial
- type diabetes
- stem cells
- patient reported outcomes
- mesenchymal stem cells
- atrial fibrillation
- smoking cessation
- replacement therapy
- phase ii