Impact of QRS Duration and Ventricular Pacing on Clinical and Arrhythmic Outcomes in Continuous Flow Left Ventricular Assist Device Recipients: A Multicenter Study

Rakesh Gopinathannair, Henri Roukoz, Jaimin R. Trivedi, Jennifer Cowger, Adarsh Bhan, Ashwin Ravichandran, Geetha Bhat, Emma J. Birks, Mark S. Slaughter, Mustafa M. Ahmed

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Objectives: Wide QRS duration and ventricular pacing are common in recipients of continuous-flow left ventricular assist devices (CF-LVADs) but their impact on outcomes remains unclear. We assessed the clinical and arrhythmic outcomes of CF-LVAD patients with wide QRS or right ventricular (RV) pacing at baseline, compared with those with narrow QRS and those with continued cardiac resynchronization therapy (CRT). Methods and Results: A total of 520 patients (57 ± 13 years) with an implantable cardioverter-defibrillator (ICD) (n = 240) or CRT-defibrillator (n = 280) who underwent CF-LVAD implantation at 5 centers in 2007–2015 were studied. Patients were divided into 3 groups: ICD-N (QRS ≤120 ms; n = 134), ICD-W (QRS >120 ms; n = 106), and CRT (n = 280). Mortality, hospitalization, and ventricular arrhythmia (VA) incidence were compared among the groups. Baseline QRS duration was different among the groups (100 ± 13 [ICD-N] vs 155 ± 26 [ICD-W] vs 159 ± 29 ms [CRT]; P < .0001). In the ICD-W group, 37 (35%) had >80% RV pacing at baseline. Median biventricular pacing in the CRT group was 96%. Over 523 days of CF-LVAD support, Kaplan-Meier analysis showed no difference in survival among groups (log rank P = .9). According to multivariate Cox regression, wide QRS duration and RV pacing were not associated with survival. QRS narrowed during CF-LVAD support in the ICD-W and CRT groups but was not associated with improved survival (P = .9). No differences were noted among the groups in hospitalizations (P = .9), VA (P = .2), or ICD shocks (P = .06). Conclusions: In this large CF-LVAD cohort, a wide QRS duration, high percentage of RV pacing at baseline, and changes in QRS duration after LVAD implantation were not associated with survival. Continued CRT after CF-LVAD implantation also was not associated with improved survival or HF hospitalizations.

Original languageEnglish (US)
Pages (from-to)355-363
Number of pages9
JournalJournal of cardiac failure
Volume25
Issue number5
DOIs
StatePublished - May 2019

Bibliographical note

Funding Information:
The authors thank Dmitry Familtsev, MD, PhD, Rahul Dhawan, MD, and Munazzah Abdullah, MD, for their contributions to data collection for this project. Rakesh Gopinathannair: Consultant/Speakers Bureau for Abbott Medical, Pfizer, Bristol Myers Squibb, and Zoll Medical; Advisory Board for HealthTrust PG. Henri Roukoz: Consultant for Boston Scientific. Jennifer Cowger: Steering Committee for Medtronic; research-related travel support from Abbott; institutional clinical trial research support from Medtronic and Abbott. Mark S. Slaughter: research grant from Heartware; Advisory Board for Oregon Heart (no compensation). Other authors: None.

Publisher Copyright:
© 2019 Elsevier Inc.

Keywords

  • Left ventricular assist device
  • cardiac resynchronization therapy
  • heart failure
  • hospitalization
  • right ventricular pacing
  • ventricular arrhythmias
  • wide QRS

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