Preoperative Atrial Fibrillation Does Not Impact Long-Term Survival and Complications in Left Ventricular Assistance Device Recipients.

Abstract

Introduction: A substantial proportion of patients receiving left ventricular assist devices (LVADs) present with pre-existing atrial fibrillation (AF). However, the prognostic significance of AF-particularly regarding overall survival and ventricular arrhythmias (VAs)-remains unclear.

Methods: Patients included were those from the multicenter ASSIST-ICD observational study. The association between AF and the primary endpoint of all-cause mortality was evaluated using a 1:1 propensity score-matched cohort. Secondary outcomes included cardiovascular and non-cardiac mortality, bleeding, stroke, pump thrombosis, and the occurrence of early (≤ 30 days post-implant) and late VAs.

Results: Among 652 LVAD recipients, 286 patients (43.9%) had a history of AF before LVAD implantation, with a median follow-up of 9.1 months (2.5-22.1). AF patients were older, with higher rates of dilated cardiomyopathy, a history of VAs, and longer heart failure duration. After matching, AF was not associated with higher mortality (HR 0.93 [0.69-1.26]). AF subtype (paroxysmal, persistent, permanent) had no impact on mortality. There were no significant differences in cardiovascular/non-cardiac mortality, bleeding, ischemic stroke, pump thrombosis, or early VAs. However, AF was linked to a higher incidence of late VAs.

Conclusion: In this large multicenter study, AF before LVAD implantation was not associated with increased risks of mortality, bleeding, stroke, or pump thrombosis, but was linked to a higher incidence of late VAs. These findings, based on earlier-generation devices, should be interpreted cautiously given the recent adoption of the HeartMate 3, offering improved hemocompatibility. Further studies are needed to identify LVAD patients where AF carries clinical significance and guide optimal management.