Impact of Atrial Fibrillation on Hemocompatibility-Related Adverse Events and Survival in Patients with the HeartMate II and HeartMate III LVADs

Objectives: Hemocompatibility-related adverse events (HRAEs) remain the Achilles heel of left ventricular assist devices (LVADs). Atrial fibrillation (AF) is associated with an increased all-cause mortality in heart failure (HF). However, the effect of AF on HRAEs in LVAD-patients is uncertain. This study sought to determine the effect of AF on outcomes in patients with the HeartMate II (HMII) and the HM3 LVADs.

Methods: Records of 138 patients who underwent HMII (n = 98) and HM3 (n = 40) implantation at a single center were reviewed. The associations of AF with HRAEs, survival, and HF hospitalization were examined.

Results: Among 138 patients, 37 (26.8%) had AF. Twenty-six patients (70%) had paroxysmal AF (PAF), 5 (13.5%) had persistent AF (PeAF), and 6 (16.2%) had permanent AF. Baseline characteristics were comparable between AF and non-AF groups. Six patients (16%) in the AF-group converted in sinus-rhythm during 30 POD. Five patients in the non-AF group developed PeAF postoperatively. The 1-year survival free from HRAEs was comparable between groups (25 vs. 27%, log-rank Mantel-Cox p = 0.725). The overall survival during a median follow-up of 29 months was also comparable between AF and non-AF groups (log-rank p = 0.094). Incidence of the breakdown of HRAEs was comparable between groups except for higher rate of bleeding events in the AF group (20 vs. 10%, p = 0.019). Rates of HF hospitalization were similar between groups (p = 0.223). ICU stay and length of hospital stay did not differ between groups.

Conclusion: Existence of preoperative AF does not affect the development of HRAEs following HMII and HM3 implantation. Aggressive anticoagulation strategies and treatment of AF before or after LVAD implantation need to be readdressed.