Permanent Atrial Fibrillation and 1-year Clinical Outcome in Patients with Left Ventricular Assist Device Implants

Objectives: In end-stage heart failure patients with left ventricular assist device implants (LVAD), thromboembolic events are life-threatening complications leading to limited LVAD support times. We aimed to investigate the association of permanent atrial fibrillation with thromboembolic events, gastrointestinal bleeding and 1-year survival in LVAD patients supported with HeartWare (HVAD) or HeartMate II (HMII) implants.

Methods: From January 2009 until May 2014, 432 patients received HVAD or HMII implants at our center. We excluded 110 patients with paroxysmal atrial fibrillation or missing ECG values leaving 322 patients who finally entered our data analysis (205 patients with sinus rhythm, designated SR group; 117 patients with permanent atrial fibrillation, designated AF group). Statistical analysis was performed using propensity score (PS) adjustment. Primary endpoint was survival up to one year. Secondary endpoints were cerebrovascular accidents, pump thrombosis and gastrointestinal bleeding during follow up.

Results: The survival rate up to one year was 71.7% in the SR group and 63.2% in the AF group (p = 0.062). PS-adjusted 1-year mortality with the SR group as reference was for the AF group = 1.33 (95% confidence interval: 0.87–2.04; p = 0.192). In the SR and AF group, 1-year freedom from cerebrovascular accidents was 84.4% and 82.9%, respectively (p = 0.622), 1-year freedom from pump thrombosis was 92.7 and 94.9%, respectively (p = 0.575), and 1-year freedom from gastrointestinal bleeding was 79.5% and 82.9%, respectively (p = 0.584).

Conclusion: Permanent atrial fibrillation is not a risk factor for poor clinical outcome in end-stage heart failure patients supported with HVAD or HMII implants.