Prognostic significance of atrial fibrillation resolution after left ventricular assist device implantation

JHLT Open Pub Date : 2026-08-01 Epub Date: 2026-07-03 DOI:10.1016/j.jhlto.2026.100624

Daisuke Yakabe, Kazuo Sakamoto, Komei Mizokami, Tsukasa Watanabe, Hirotake Yokoyama, Sayana Kuraoka, Kayo Misumi, Tomomi Nagayama, Keisuke Shinohara, Takeo Fujino, Toru Hashimoto, Shouji Matsushima, Akira Shiose, Kohtaro Abe

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Abstract

Background

The clinical impact of atrial fibrillation (AF) in patients undergoing left ventricular assist device (LVAD) implantation remains uncertain, particularly regarding whether the post-LVAD rhythm status carries prognostic value.

Methods

We retrospectively reviewed consecutive LVAD recipients at our institution between 2008 and 2023. Patients were categorized as no AF, new-onset AF, resolved AF, or recurrent AF according to rhythm status before and after implantation. The primary endpoint was hospitalization for heart failure, and the secondary endpoints were all-cause death, stroke, and major bleeding. Left atrial (LA) reverse remodeling was quantified as the percent reduction in LA diameter.

Results

Among 115 patients (mean age 46 years; 69.6% male; 14.8% ischemic etiology), 44 (38.3%) had AF before implantation. Over a median follow-up of 50.8 months, 29 of 44 patients (65.9%) had no AF recurrence by 3 months after implantation (resolved AF group), whereas 15 had AF (recurrent AF group); among the 71 patients without pre-LVAD AF, three developed new-onset AF. Compared with the recurrent AF group, the resolved AF group had a significantly lower risk of heart failure hospitalization (hazard ratio, 0.25; 95% confidence interval, 0.07–0.86; P = 0.027). LA diameter decreased to a greater extent in the resolved AF group than in the recurrent AF group (LA reduction rate: 24.5% vs. 10.8%; P = 0.032).

Conclusions

LVAD implantation was associated with LA reduction through reverse remodeling and led to AF resolution in a subset of patients. Patients with AF resolution experienced fewer heart failure events during LVAD support.

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左室辅助装置植入后房颤消退的预后意义。

背景：接受左心室辅助装置（LVAD）植入的患者心房颤动（AF）的临床影响仍然不确定，特别是关于LVAD后心律状态是否具有预后价值。方法：我们回顾性分析了2008年至2023年间我院连续LVAD受者。根据植入前后的心律状态将患者分为无房颤、新发房颤、缓解房颤和复发房颤。主要终点是因心力衰竭住院，次要终点是全因死亡、中风和大出血。左房（LA）反向重构量化为左房直径缩小百分比。结果：115例患者（平均年龄46岁，男性69.6%，缺血性病因14.8%），植入前房颤44例（38.3%）。在50.8个月的中位随访中，44例患者中有29例（65.9%）在植入后3个月无房颤复发（AF消退组），而15例发生房颤（AF复发组）；在71例未发生lvad前房颤的患者中，有3例发生了新发房颤。与复发房颤组相比，房颤消退组发生心力衰竭住院的风险明显降低（风险比为0.25；95%可信区间为0.07-0.86;P = 0.027）。与复发性房颤组相比，消退性房颤组的LA直径减小幅度更大（LA减小率：24.5% vs 10.8%; P = 0.032）。结论：LVAD植入通过反向重塑与LA降低相关，并导致部分患者房颤消退。房颤消退的患者在LVAD支持期间发生的心力衰竭事件较少。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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JHLT Open

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