Po-04-191 risk factors and outcomes of early ventricular arrhythmias after left ventricular assist device implantation

Ventricular arrhythmias (VAs) may occur during the early post-operative period after the implantation of left ventricular assist device (LVAD). The factors associated with its development and the long-term clinical outcome are unclear. This study aimed to evaluate the risk factors and outcomes of early ventricular arrhythmias <30 days after LVAD implantation. We performed a retrospective cohort study on all patients who underwent LVAD implantation at the Mayo Clinic (Rochester, Phoenix, and Jacksonville) from January 1, 2001, to December 31, 2020. Early VAs were defined as sustained (>30 seconds) ventricular tachycardia or ventricular fibrillation occurring less than 30 days after the LVAD implantation. Detailed review of the electronic health records within the Mayo Clinic and outside medical records were performed. A total of 886 patients were included in the study, with a median age of 60 years (interquartile range [IQR]: 50-67), and 78.9% were male. A total of 195 (22.1%) patients had early VAs after LVAD implant. Pre-implant characteristics associated with early VAs were history of VAs (32.8% vs 23.9% p=0.012), history of ventricular tachycardia ablation (5.6% vs 2.0%, p=0.007), history of ICD shocks (32.3% vs 20.1%, p<0.001) and the use of mexiletine (16.4% vs 5.9%, p<0.001) and sotalol (8.2% vs 3.6% p=0.007) before LVAD. There was no difference in the subsequent risk of late VAs in patients with or without early VAs (27.7% vs. 25.8%, p=0.29). The 1-year post LVAD mortality rate was higher in patients with early VAs compared to patients without early VAs (32% vs 18%, P<0.01). Early VAs occur in 22.1% of patients undergoing LVAD implant and is associated with increased 1-year post LVAD mortality. Significant pre-implant risk factors include a history of VAs, ICD shocks, and anti-arrhythmic drug use before the procedure.