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Electrical storm in patients with left ventricular assist devices: Risk factors, incidence, and impact on survival.

Publication ,  Journal Article
Rehorn, MR; Black-Maier, E; Loungani, R; Sen, S; Sun, AY; Friedman, DJ; Koontz, JI; Schroder, JN; Milano, CA; Khouri, MG; Katz, JN; Patel, CB ...
Published in: Heart Rhythm
August 2021

BACKGROUND: Ventricular arrhythmias (VAs) and electrical storm (ES) are recognized complications following left ventricular assist device (LVAD) implantation; however, their association with long term-outcomes remains poorly understood. OBJECTIVE: The purpose of this study was to describe the clinical impact of ES in a population of patients undergoing LVAD implantation at a quaternary care center in the United States. METHODS: This was an observational retrospective study of patients undergoing LVAD implantation from 2009 to 2020 at Duke University Hospital. The incidence of ES (≥3 sustained VA episodes over a 24-hour period without an identifiable reversible cause) was determined from patient records. Risk factors for ES were identified using multivariable Cox proportional hazards modeling. RESULTS: Among 730 patients undergoing LVAD implant, 78 (10.7%) developed ES at a median of 269 (interquartile range [IQR] 7-766) days following surgery. Twenty-seven patients (34.6%) developed ES within 30 days, while 51 (65.4%) presented with ES at a median 639 (IQR 281-1017) days after implant. Following ES, 41% of patients died within 1 year. Patients who developed ES were more likely to have a history of VAs, ventricular tachycardia ablation, antiarrhythmic drug use, and perioperative mechanical circulatory support around the time of LVAD implant than patients without ES. CONCLUSION: ES occurs in 1 in 10 patients after LVAD and is associated with higher mortality. Risk factors for ES include a history of VAs, VT ablation, antiarrhythmic drug use, and perioperative mechanical circulatory support. Optimal management of ES surrounding LVAD implant, including escalation of medical therapy, catheter ablation, or adjunctive sympatholytic therapies, remains uncertain.

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Published In

Heart Rhythm

DOI

EISSN

1556-3871

Publication Date

August 2021

Volume

18

Issue

8

Start / End Page

1263 / 1271

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Tachycardia, Ventricular
  • Survival Rate
  • Risk Factors
  • Retrospective Studies
  • Middle Aged
  • Male
  • Incidence
  • Humans
 

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Rehorn, M. R., Black-Maier, E., Loungani, R., Sen, S., Sun, A. Y., Friedman, D. J., … Piccini, J. P. (2021). Electrical storm in patients with left ventricular assist devices: Risk factors, incidence, and impact on survival. Heart Rhythm, 18(8), 1263–1271. https://doi.org/10.1016/j.hrthm.2021.03.047
Rehorn, Michael R., Eric Black-Maier, Rahul Loungani, Sounok Sen, Albert Y. Sun, Daniel J. Friedman, Jason I. Koontz, et al. “Electrical storm in patients with left ventricular assist devices: Risk factors, incidence, and impact on survival.Heart Rhythm 18, no. 8 (August 2021): 1263–71. https://doi.org/10.1016/j.hrthm.2021.03.047.
Rehorn MR, Black-Maier E, Loungani R, Sen S, Sun AY, Friedman DJ, et al. Electrical storm in patients with left ventricular assist devices: Risk factors, incidence, and impact on survival. Heart Rhythm. 2021 Aug;18(8):1263–71.
Rehorn, Michael R., et al. “Electrical storm in patients with left ventricular assist devices: Risk factors, incidence, and impact on survival.Heart Rhythm, vol. 18, no. 8, Aug. 2021, pp. 1263–71. Pubmed, doi:10.1016/j.hrthm.2021.03.047.
Rehorn MR, Black-Maier E, Loungani R, Sen S, Sun AY, Friedman DJ, Koontz JI, Schroder JN, Milano CA, Khouri MG, Katz JN, Patel CB, Pokorney SD, Daubert JP, Piccini JP. Electrical storm in patients with left ventricular assist devices: Risk factors, incidence, and impact on survival. Heart Rhythm. 2021 Aug;18(8):1263–1271.
Journal cover image

Published In

Heart Rhythm

DOI

EISSN

1556-3871

Publication Date

August 2021

Volume

18

Issue

8

Start / End Page

1263 / 1271

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Tachycardia, Ventricular
  • Survival Rate
  • Risk Factors
  • Retrospective Studies
  • Middle Aged
  • Male
  • Incidence
  • Humans