Clinical InvestigationProlonged Repolarization After Ventricular Assist Device Support Is Associated With Arrhythmias in Humans With Congestive Heart Failure
Section snippets
Patient Population
We examined temporal changes in the surface 12-lead ECG in 17 consecutive patients who were placed on LVAD support at the Hospital of the University of Pennsylvania and Temple University Hospital between June 2001 and December 2002. Patients transferred to either center on VAD support and those who did not survive VAD implantation were not enrolled in this trial. Informed consent was obtained from all patients and each university's institutional review board approved the protocol. Twelve-lead
Clinical Characteristics
The 17 patients were predominantly male (12 of 17), with a mean ejection fraction of 14 ± 9 percent. Heart failure duration among these patients averaged 30 ± 11 months (range 2 days to 280 months); 7 patients had clinical CHF for 3 months or less. The etiology of HF among the study population was primarily from coronary artery disease, with 10 ischemic cardiomyopathies, 6 idiopathic cardiomyopathies, and 1 patient with myocarditis. Pre-LVAD antiarrhythmic therapy consisted of amiodarone in 9
Discussion
Ventricular assist devices provide a unique opportunity to examine how the failing human heart responds to substantial hemodynamic unloading. Indeed, virtually all patients show improved hemodynamic parameters after LVAD placement in association with increased effective cardiac output and systemic perfusion. Despite improved overall clinical stability, the present study suggests that a substantial proportion of patients with LVAD support will have ventricular arrhythmias in the early
Conclusions
Although sustained mechanical support (>1 week) induces regression of the pathologic phenotype of the failing heart,12 including improvements in parameters reflecting myocardial repolarization, the initial period of mechanical support is associated with an increased incidence of ventricular arrhythmias. These arrhythmias tend to be closely associated with early increases in the ΔQTc interval. This observation implicates abnormalities in repolarization because of mechanical unloading as a
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Cardiovascular implantable electronic device therapy in patients with left ventricular assist devices: insights from TRAViATA
2021, International Journal of CardiologyCitation Excerpt :Some studies have suggested that CRT, especially in non-responders, may potentially promote ventricular arrhythmias through increasing transmural dispersion of repolarization [20]. Following LVAD implantation, those with prolonged repolarization have been similarly shown to be at higher risk of ventricular arrhythmia [21]. As those with LVADs may be considered CRT non-responders by default, an unintended increase in repolarization dispersion caused by continued CRT may overtime lead to frequent ventricular arrhythmias.
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2019, Cardiac Electrophysiology ClinicsCitation Excerpt :Electrocardiograms (ECGs) taken within 6 hours post-LVAD implant demonstrated statistically significant shortening of QRS duration and increase in QT and QTc duration (379 ± 10 to 504 ± 11 ms).22 Mechanistic possibilities include inactivation of the swelling-activated chloride channel and an increase in the NCX.14 PVC triggered VT or VF was observed in approximately 2.5% of the LVAD patients.19,23
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