Arrhythmias after Implantation of the Left Ventricular Assisted Device: Arrhythmias after Implantation of the Left Ventricular Assisted Device

Bashar  Albkhoor; Khalid  Alnawaisheh; Razi Abo  Anzeh; Zyad  Alfawaeer; Hanan  Alrawashdeh

doi:10.52229/pbmj.v2i2.32

Authors

Bashar Albkhoor Queen Aliya Hospital, Amman, Jordan
Khalid Alnawaisheh Queen Aliya Hospital, Amman, Jordan
Razi Abo Anzeh Queen Aliya Hospital, Amman, Jordan
Zyad Alfawaeer Queen Aliya Hospital, Amman, Jordan
Hanan Alrawashdeh Queen Aliya Hospital, Amman, Jordan

DOI:

https://doi.org/10.52229/pbmj.v2i2.32

Abstract

Cardiac arrhythmias has been frequently reported after left ventricular assist devices implantation but currently literature shows no sufficient information on cardiac arrhythmias. Objective: The aim of this study was to assess the frequency and other features of ventricular and supra ventricular ectopic beats ((SVEB), atrial fibrillation (AF)/flutter (AFL) post device implantation. Methods:This is a retrospective study conducted in Department of Cardiac-Surgery, University of Verona Medical School, Verona, Italy from June 2014-September 2016. Rhythm monitoring and registration were collected from 16 patients (13 males; 45±13years) during the first five (05) days after implantation. To assess late post-operative rhythm, patient’s hospital electronic records were used as well asfunctional hemodynamic parameters including mean arterial pressure(MAP), right atrial pressure(RAP), heart rate(HR) and ST-deviation(d-ST). Results: Ventricular arrhythmia (n=9), atrial fibrillation (n=5) or atrial flutter (n=2) episodes were preoperatively present in 11 patients. Postoperatively, 5 patients developed either VT (n=2), AF (n=1) or both VT/AF (n=2) during a follow-up of 18±14 months. Prior to postoperative VT (POVT) episodes (n=123), MAP decreased, HR, d-ST increased and RAP remained unaltered. POVT were initiated either by single VEBS (28%), V-couplets (15%), V-run (46%) or occurred suddenly (11%).Conclusions: Ventricular and supraventricular arrhythmias are common after device implantation. The frequency of sustained VTA was less at early phase as compared to late postoperative phase.

References

Dickstein, K. (2008). ESC Committee for Practice Guidelines (CPG): ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology: Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J, 29, 2388-2442.

Corporation, T.; Available from:http://www.thoratec.com/medical-professionals/vad-product-information/heartmate-ll-lvad.aspx.

Bedi, M., Kormos, R., Winowich, S., McNamara, D. M., Mathier, M. A., & Murali, S. (2007). Ventricular arrhythmias during left ventricular assist device support. The American Journal of Cardiology, 99(8), 1151-1153.

Refaat, M., Chemaly, E., Lebeche, D., Gwathmey, J. K., & Hajjar, R. J. (2008). Ventricular arrhythmias after left ventricular assist device implantation. Pacing and Clinical Electrophysiology, 31(10), 1246-1252.

Shirazi, J. T., Lopshire, J. C., Gradus-Pizlo, I., Hadi, M. A., Wozniak, T. C., & Malik, A. S. (2013). Ventricular arrhythmias in patients with implanted ventricular assist devices: a contemporary review. Europace, 15(1), 11-17.

Starling, R. C., Naka, Y., Boyle, A. J., Gonzalez-Stawinski, G., John, R., Jorde, U., Russell, S.D., Conte, J.V., Aaronson, K.D., McGee, E.C. & Cotts, W. G. (2011). Results of the post-US Food and Drug Administration-approval study with a continuous flow left ventricular assist device as a bridge to heart transplantation: a prospective study using the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support). Journal of the American College of Cardiology, 57(19), 1890-1898.

Brenyo, A., Rao, M., Koneru, S., Hallinan, W., Shah, S., Massey, H. T., Chen, L., Polonsky, B., McNitt, S., Huang, D.T. & Goldenberg, I. (2012). Risk of mortality for ventricular arrhythmia in ambulatory LVAD patients. Journal of Cardiovascular Electrophysiology, 23(5), 515-520.

Ataklte, F., Erqou, S., Laukkanen, J., & Kaptoge, S. (2013). Meta-analysis of ventricular premature complexes and their relation to cardiac mortality in general populations. The American Journal of Cardiology, 112(8), 1263-1270.

Sajadieh, A., Nielsen, O. W., Rasmussen, V., Hein, H. O., Frederiksen, B. S., Davanlou, M., & Hansen, J. F. (2006). Ventricular arrhythmias and risk of death and acute myocardial infarction in apparently healthy subjects of age≥ 55 years. The American Journal of Cardiology, 97(9), 1351-1357.

Binici, Z., Intzilakis, T., Nielsen, O. W., Køber, L., & Sajadieh, A. (2010). Excessive supraventricular ectopic activity and increased risk of atrial fibrillation and stroke. Circulation, 121(17), 1904-1911.

Andersen, M., Videbæk, R., Boesgaard, S., Sander, K., Hansen, P. B., & Gustafsson, F. (2009). Incidence of ventricular arrhythmias in patients on long-term support with a continuous-flow assist device (HeartMate II). The Journal of Heart and Lung Transplantation, 28(7), 733-735.

Kirklin, J. K., Naftel, D. C., Stevenson, L. W., Kormos, R. L., Pagani, F. D., Miller, M. A., Ulisney, K. & Young, J. B. (2008). INTERMACS database for durable devices for circulatory support: first annual report. The Journal of Heart and Lung Transplantation, 27(10), 1065-1072.

Miller, L. W., Pagani, F. D., Russell, S. D., John, R., Boyle, A. J., Aaronson, K. D., Conte, J.V., Naka, Y., Mancini, D., Delgado, R.M. & MacGillivray, T. E. (2007). Use of a continuous-flow device in patients awaiting heart transplantation. New England Journal of Medicine, 357(9), 885-896.

Pagani, F. D., Miller, L. W., Russell, S. D., Aaronson, K. D., John, R., Boyle, A. J., Conte, J.V., Bogaev, R.C., MacGillivray, T.E., Naka, Y. & Mancini, D. (2009). Extended mechanical circulatory support with a continuous-flow rotary left ventricular assist device. Journal of the American College of Cardiology, 54(4), 312-321.

Raasch, H., Jensen, B. C., Chang, P. P., Mounsey, J. P., Gehi, A. K., Chung, E. H., Sheridan, B.C., Bowen, A. & Katz, J. N. (2012). Epidemiology, management, and outcomes of sustained ventricular arrhythmias after continuous-flow left ventricular assist device implantation. American Heart Journal, 164(3), 373-378.

Ziv, O., Dizon, J., Thosani, A., Naka, Y., Magnano, A. R., & Garan, H. (2005). Effects of left ventricular assist device therapy on ventricular arrhythmias. Journal of the American College of Cardiology, 45(9), 1428-1434.

Dandel, M., Knosalla, C., & Hetzer, R. (2014). Contribution of ventricular assist devices to the recovery of failing hearts: a review and the B erlin H eart C enter E xperience. European Journal of Heart Failure, 16(3), 248-263.

Roelke, M., Garan, H., McGovern, B. A., & Ruskin, J. N. (1994). Analysis of the initiation of spontaneous monomorphic ventricular tachycardia by stored intracardiac electrograms. Journal of the American College of Cardiology, 23(1), 117-122.

Saeed, M., Link, M. S., Mahapatra, S., Mouded, M., Tzeng, D., Jung, V., Contreras, R., Swygman, C., Homoud, M., Estes III, N.M. & Wang, P. J. (2000). Analysis of intracardiac electrograms showing monomorphic ventricular tachycardia in patients with implantable cardioverter-defibrillators. The American Journal of Cardiology, 85(5), 580-587.

Gomes, J. A., Alexopoulos, D., Winters, S. L., Deshmukh, P., Fuster, V., & Suh, K. (1989). The role of silent ischemia, the arrhythmic substrate and the short-long sequence in the genesis of sudden cardiac death. Journal of the American College of Cardiology, 14(7), 1618-1625.

Moscato, F., Granegger, M., Edelmayer, M., Zimpfer, D., & Schima, H. (2014). Continuous monitoring of cardiac rhythms in left ventricular assist device patients. Artificial Organs, 38(3), 191-198.

Chong, B. H., Pong, V., Lam, K. F., Liu, S., Zuo, M. L., Lau, Y. F., Lau, C.P., Tse, H.F.& Siu, C. W. (2012). Frequent premature atrial complexes predict new occurrence of atrial fibrillation and adverse cardiovascular events. Europace, 14(7), 942-947.