Impact of Cardiac Resynchronization Therapy on Ventricular Arrhythmias and Survival After Durable Left Ventricular Assist Device Implantation

Connor P Oates; Luke L Lawrence; Grace E Bigham; Namratha S Meda; Binaya Basyal; Sriram D Rao; Cyrus A Hadadi; Samer S Najjar; Manish H Shah; Farooq H Sheikh; Phillip H Lam

doi:10.1097/MAT.0000000000002279

Impact of Cardiac Resynchronization Therapy on Ventricular Arrhythmias and Survival After Durable Left Ventricular Assist Device Implantation

ASAIO J. 2024 Jul 29. doi: 10.1097/MAT.0000000000002279. Online ahead of print.

Authors

Connor P Oates^{1

2}, Luke L Lawrence^{1

2}, Grace E Bigham^{1

2}, Namratha S Meda^{1

2}, Binaya Basyal^{1

2}, Sriram D Rao^{1

2

3}, Cyrus A Hadadi^{1

2}, Samer S Najjar^{1

2}, Manish H Shah^{1

2}, Farooq H Sheikh^{1

2}, Phillip H Lam^{1

2}

Affiliations

¹ From the MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia.
² Georgetown University School of Medicine, Washington, District of Columbia.
³ MonashHeart, Monash Health, Clayton, Victoria, Australia.

PMID: 39074441
DOI: 10.1097/MAT.0000000000002279

Abstract

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.