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Persistent AF increased mortality, HF hospitalization in patients with LVADs

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In patients with a left ventricular assist device, persistent atrial fibrillation was associated with an increased risk for mortality and hospitalization for HF, according to new data.

Researchers studied 106 patients (mean age, 56.6 years; 82.1% men) who were implanted with the HeartMate II LVAD (Thoratec Corp.) at a single center. The researchers examined the associations of paroxysmal AF and persistent AF with survival, hospitalization for HF, bleeding and thromboembolism.

In 87.7% of patients, LVAD implantation was intended as bridge to transplantation, and the median length of support was 217 days, according to the researchers. More than 19% of patients died, 56.6% survived to transplantation, 2.8% had the LVAD explanted because of myocardial recovery, 17.9% reached the end of follow-up and 2.9% were followed at other centers after implantation.

Thirty-four percent of patients had paroxysmal AF and 17.9% had persistent AF. During the study period, 17% were hospitalized for HF. On average, there were 0.75 major bleeding events per patient-year of follow-up and 0.28 thromboembolic events per patient-year of follow-up.

The researchers found no association between paroxysmal AF and increased risk for mortality, HF hospitalization, bleeding or thromboembolism. However, in this patient population, persistent AF was an independent predictor of the composite endpoint of death or HF hospitalization (HR=3.54; 95% CI, 1.52-8.25).

In addition, there was no increase in bleeding or thromboembolism among patients with persistent AF. However, compared with patients with no AF, those with any AF had a higher INR at the time of the thromboembolic event (2.7 vs. 1.54; P=.003) and at 4 weeks leading up to the event (2.33 vs. 1.57; P=.006).

“To our knowledge, this is the first study to show an increased risk of mortality or HF hospitalization with AF in this patient population and the first to support a higher target INR in patients with AF,” Alan D. Enriquez, MD, from the cardiovascular division at Brigham and Women’s Hospital, and colleagues wrote.

In a related editorial, Peter M. Eckman, MD, from the division of cardiovascular medicine, department of medicine, University of Minnesota, Minneapolis, said the finding for patients with paroxysmal AF “suggests that any hemodynamic effect of intermittent AF in the HeartMate II population is likely to be minimal and that conventional anticoagulation is appropriate for this group.”

However, for patients with persistent AF receiving an LVAD, “validation of these findings in larger cohorts and additional centers would be important before advocating significant changes in the protocols currently recommended,” Eckman wrote.

For more information:

Eckman PM. J Am Coll Cardiol. 2014;64:1891-1893.

Enriquez AD. J Am Coll Cardiol. 2014;64:1883-1890.

Disclosure: One researcher reports financial ties with Acorda Therapeutics, CareDX and Thoratec. Eckman reports financial ties with HeartWare and Thoratec.