Eastern Cardiothoracic Surgical Society

Impact of Chronic Atrial Fibrillation on Survival in Left Ventricular Assist Device Implantation as Destination Therapy Patients
Alexis K. Okoh, Molly Schultheis, Claudia Gidea, Janice Pieretti, Mark Zucker, Mark Russo, Margarita T. Camacho, Newark Beth Israel Medical Center, Newark, NJ


OBJECTIVE: To investigate the impact of baseline chronic atrial fibrillation(CAF) on survival in patients who had LVAD as destination therapy at a single center.

METHODS: Patients who underwent LVAD implantation as destination therapy at a single center were studied. Patients were classified into two groups based on baseline CAF status: (Normal sinus rhythm (NSR) vs. CAF). Baseline clinical characteristics and post-LVAD implant adverse events were compared. Cox-proportional hazards model, Kaplan Meir survival curves were used to identify predictors and assess survival. Unadjusted mortality rates at 1-year, 2-years and overall were analyzed.

RESULTS: Out of 91 patients studied, 32 (35%) had chronic AF before LVAD implant. Baseline characteristics were similar in both groups. Post-LVAD adverse events did not differ between the two groups, Overall complications (p=0.465), malfunction and thrombosis (p=0.835), major infection (p=0.129) and re-hospitalization (p=0.569). Median follow up time was 19 months. On multivariable analysis, Baseline CAF was found to be an independent predictor of overall mortality (HR:2.3, 95% C.I:1.2, 4.5), p=0.009, Other predictors of mortality were age, sex and baseline moderate mitral regurgitation. Mortality rates at 1 and 2-years for both groups (NSR vs. C-AF) were (38% vs. 22%; p=0.118), (59% vs. 25%, p=0.001) respectively. Overall, survival was significantly, lower in the CAF group than the NSR group (log rank test: p=0.006).

CONCLUSIONS: A high incidence of CAF exist in advanced heart failure patients undergoing LVAD implantation as destination therapy. Baseline CAF is associated with worse post-implant survival at mid-term follow-up.