BACKGROUND:Ventricular arrhythmias (VAs) are common in patients with left ventricular assist devices (LVADs), but their prognostic impact remains uncertain. Prior studies have yielded conflicting results regarding their association with mortality and morbidity. We aimed to evaluate the incidence and clinical outcomes associated with VAs in a large, multicenter LVAD cohort. METHODS:We analyzed 408 patients who underwent LVAD implantation across five centers between 2007 and 2015. VA was defined as sustained VAs lasting > 30 s or requiring ICD therapy. The effects of pre- and post-LVAD VA on clinical outcomes-including survival, hospitalizations, and ICD shocks-were assessed. RESULTS:Of 408 patients, 254 (62%) had a history of pre-LVAD VA. Compared to those without prior VA, patients with pre-LVAD VA were more likely to be male (85% vs. 75%, p = 0.02), receive amiodarone (44% vs. 31%, p = 0.01), and have larger left ventricular end-diastolic dimension (LVEDD) (7.1 vs. 6.8 cm, p = 0.01). Postimplant, the pre-VA group had a significantly higher incidence of VA (73% vs. 37%, p < 0.0001), atrial arrhythmias (63% vs. 42%, p < 0.0001), ICD shocks (41% vs. 32%, p = 0.001), and cardiac hospitalizations (median 0.20 vs. 0.08 events/year, p = 0.0003). However, Kaplan-Meier survival analysis showed no significant difference in overall mortality (log-rank p = 0.10). On multivariate Cox regression, pre-LVAD VA predicted post-LVAD VA, but LVEDD was the only independent predictor of mortality. CONCLUSIONS:In this multicenter cohort, pre-LVAD VAs were strongly associated with postimplant arrhythmic burden and increased morbidity, but not with long-term mortality. These findings highlight the importance of structural factors such as LVEDD over arrhythmia history in survival outcomes and underscore the need for individualized arrhythmia surveillance and management strategies in LVAD recipients with prior VAs.

BACKGROUND:Direct current cardioversion (DCCV) is commonly used for rhythm control in atrial fibrillation (AF). Left atrial appendage occlusion (LAAO) provides stroke prevention in patients with contraindications to oral anticoagulation (OAC), but the safety of DCCV without periprocedural anticoagulation in this group remains uncertain. OBJECTIVE:To evaluate the safety of performing DCCV without systemic anticoagulation in patients with prior LAAO. METHODS:We conducted a systematic review and meta-analysis following PRISMA guidelines. PubMed, ScienceDirect, and the Cochrane Library were searched (January 2010-April 2025). Studies comparing outcomes of patients undergoing DCCV after LAAO, with versus without subsequent anticoagulation, were included. Primary outcomes were thromboembolic events and clinically significant bleeding. Odds ratios (ORs) were calculated using random-effects modeling, with heterogeneity assessed via I2 statistic. RESULTS:Five observational studies (1697 DCCV procedures; 965 patients receiving post-DCCV anticoagulation) met inclusion criteria. Thromboembolic events occurred in 3.8 % of patients without OAC versus 1.6 % with OAC, with no statistically significant difference (OR 0.48; 95 % CI 0.16-1.43; p = 0.19; I2 = 17 %). Clinically significant bleeding occurred in 4.1 % without OAC and 4.0 % with OAC, also without significant difference (OR 1.22; 95 % CI 0.75-2.00; p = 0.42; I2 = 0 %). Pre-DCCV imaging protocols varied widely among studies. CONCLUSIONS:In selected patients post-LAAO with no device-related thrombus or significant peri-device leak, DCCV without subsequent anticoagulation demonstrated low thromboembolic and bleeding risks. These findings, derived from limited observational data, require confirmation by randomized controlled trials.

Background Genetic and familial contributions to early‐onset atrial fibrillation are described primarily in individuals of European ancestry. However, the role of racial and familial contributions in the pathogenesis of early‐onset atrial flutter ( EOAFL ) is unclear. Methods and Results In this cross‐sectional study, participants were enrolled prospectively from 2015 to 2021 in multiple academic centers with a diagnosis of atrial flutter ( AFL) confirmed by ECG. EOAFL was defined as a diagnosis of AFL before age 66 years with no concomitant or previous diagnosis of atrial tachyarrhythmias. Family history was adjudicated through baseline questionnaires and direct family interviews about the diagnosis of atrial tachyarrhythmias, stroke, and cardiomyopathy. The primary exposure was a positive family history in first‐degree relatives, and the primary outcome was the odds of EOAFL versus late‐onset AFL . A total of 909 patients were enrolled. Participants with a positive family history of atrial tachyarrhythmias were younger, less likely to be of Black race, and more likely to have EOAFL . The adjusted odds ratio ( OR ) for EOAFL in those with a positive family history was 1.8 (95% CI , 1.1–3.0). There was an increased odds of EOAFL in those of Black race ( OR, 2.1 [95% CI, 1.4–3.2]), alcohol use ( OR, 1.6 [95% CI, 1.0–2.6]), and obstructive sleep apnea ( OR, 1.9 [95% CI, 1.0–3.4]). Use of cardioselective β blockers or calcium channel blockers before the diagnosis of AFL were associated with a lower odds of EOAFL ( OR, 0.5 [95% CI, 0.2–0.9]). Conclusions These findings suggest a potentially hereditary predisposition to EOAFL across race and ethnicity, warranting further study of the genetic contributions to AFL .

Introduction: Cardiac arrhythmias are common in continuous flow left ventricular assist device (LVAD) recipients. The impact of axial vs. intrapericardial centrifugal LVAD pumps on arrhythmia incidence and associated clinical outcomes is unclear. Hypothesis: This multicenter study evaluated the impact of LVAD type (axial vs. centrifugal) on incidence of atrial and ventricular arrhythmias, ICD shocks and mortality in LVAD patients. Methods: Analysis was done on 536 patients who underwent LVAD implantation at 5 US centers from 2008 to 2016. The groups were divided based on their LVAD type (axial - HeartMate II [HMII, n=433] vs. centrifugal - HeartWare (HW, n=103). Baseline characteristics as well as incidence of post-LVAD atrial arrhythmias (PL-AA), ventricular arrhythmias (PL-VA) and ICD shocks were analyzed in these groups. Multivariable Cox Regression analysis was used to identify predictors of survival. Results: Of 536 patients, 433 had HMII axial LVAD and 103 had HW centrifugal VAD implant. At baseline, HMII group had more males, higher proportion of CRT-D and higher prevalence of AA (Table 1A). Left ventricular dimensions were similar between groups. During a median follow-up of 537 days of LVAD support, incidence of PL-VA and ICD shocks were significantly higher in the HM2 group compared to HW group whereas incidence of PL-AA was not significantly different (Table 1A). In multivariable Cox Regression analysis, LVAD indication was the only variable that predicted survival (Table 1B). Type of LVAD (axial vs. centrifugal) was not associated with survival (HMII vs. HW - HR 1.04, P=0.48). Conclusions: In this multi-center continuous flow LVAD cohort, axial HM2 VAD patients had a higher incidence of PL-VA and ICD shocks. Type of LVAD (axial vs. centrifugal) was not associated with survival.

BACKGROUND: Smoking is associated with increased risk of developing atrial fibrillation (AF) and stroke. Yet, it remains unclear if it also predicts response to rhythm control therapy across race-ethnicity. We sought to determine if response to rhythm control therapy for AF is modulated by smoking across race-ethnicity. Methods: 529 patients treated with a rhythm control strategy were prospectively enrolled in the Chicagoland area. Patients were classified into White, Black or Hispanic\Latino based on race\ethnicity and ancestry markers. Rhythm control included antiarrhythmic drugs (AADs) and/or catheter ablation. Successful response was defined as continuation of the same AAD for at least 6 months and/or successful catheter ablation without recurrence of AF for 12 months. Results: 235 (44%) were Black, 192 (36%) were White, and 102 (19%) were Hispanic. 299 (57%) were treated with AADs and 230 (44%) with catheter ablation. One-hundred sixty-eight (35%) patients had a history of smoking. Baseline co-morbidities were similar across responders and non-responders. In multivariate regression analysis (Table 1), patients with a smoking history were more likely to have a recurrence of AF when treated with a rhythm control strategy (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.03-2.21, P =0.03). Stratified multivariate regression analysis showed that smokers were more likely to have a recurrence of AF after ablation therapy as compared to AADs (OR 1.49, 95% CI 1.03-2.17, P = 0.03). Multivariate logistic regression showed that patients that smoked for >20 years were twice as likely to have a recurrence of AF with a rhythm control therapy than those who smoked for <20 years (OR 1.88, 95% CI 1.20- 2.93, P = 0.01). Conclusions: A smoking history modulates response to rhythm control therapy for AF across race-ethnicity. Our study highlights the importance of smoking cessation before initiation of rhythm control agents in patients with AF.

Importance:Ventricular tachycardia (VT) is associated with high mortality in patients with cardiac sarcoidosis (CS), and medical management of CS-associated VT is limited by high failure rates. The role of catheter ablation has been investigated in small, single-center studies.Objective:To investigate outcomes associated with VT ablation in patients with CS.Design, Setting, and Participants:This cohort study from the Cardiac Sarcoidosis Consortium registry (2003-2019) included 16 tertiary referral centers in the US, Europe, and Asia. A total of 158 consecutive patients with CS and VT were included (33% female; mean [SD] age, 52 [11] years; 53% with ejection fraction [EF] <50%).Exposures:Catheter ablation of CS-associated VT and, as appropriate, medical treatment.Main Outcomes and Measures:Immediate and short-term outcomes included procedural success, elimination of VT storm, and reduction in defibrillator shocks. The primary long-term outcome was the composite of VT recurrence, heart transplant (HT), or death.Results:Complete procedural success (no inducible VT postablation) was achieved in 85 patients (54%). Sixty-five patients (41%) had preablation VT storm that did not recur postablation in 53 (82%). Defibrillator shocks were significantly reduced from a median (IQR) of 2 (1-5) to 0 (0-0) in the 30 days before and after ablation (P < .001). During median (IQR) follow-up of 2.5 (1.1-4.9) years, 73 patients (46%) experienced VT recurrence and 81 (51%) experienced the composite primary outcome. One- and 2-year rates of survival free of VT recurrence, HT, or death were 60% and 52%, respectively. EF less than 50% and myocardial inflammation on preprocedural 18F-fluorodeoxyglucose positron emission tomography were significantly associated with adverse prognosis in multivariable analysis for the primary outcome (HR, 2.24; 95% CI, 1.37-3.64; P = .001 and HR, 2.93; 95% CI, 1.31-6.55; P = .009, respectively). History of hypertension was associated with a favorable long-term outcome (adjusted HR, 0.51; 95% CI, 0.28-0.92; P = .02).Conclusions and Relevance:In this observational study of selected patients with CS and VT, catheter ablation was associated with reductions in defibrillator shocks and recurrent VT storm. Preablation LV dysfunction and myocardial inflammation were associated with adverse long-term prognosis. These data support the role of catheter ablation in conjunction with medical therapy in the management of CS-associated VT.

Background Atrial and ventricular arrhythmias are commonly encountered in patients with advanced heart failure, with amiodarone being the most commonly used antiarrhythmic drug in continuous‐flow left ventricular assist device (CF‐LVAD) recipients. The purpose of this study was to assess the impact of amiodarone use on long‐term all‐cause mortality in ptients with a CF‐LVAD. Methods and Results A retrospective multicenter study of CF‐LVAD was conducted at 5 centers including all CF‐LVAD implants from 2007 to 2015. Patients were stratified based on pre–CF‐LVAD implant amiodarone use. Additional use of amiodarone after CF‐LVAD implantation was also evaluated. Primary outcome was all‐cause mortality during long‐term follow‐up. Kaplan‐Meier curves were used to assess survival outcomes. Multivariable Cox regression was used to identify predictors of outcomes. Propensity matching was done to address baseline differences. A total of 480 patients with a CF‐LVAD (aged 58±13 years, 81% men) were included. Of these, 170 (35.4%) were on chronic amiodarone therapy at the time of CF‐LVAD implant, and 310 (64.6%) were not on amiodarone. Rate of all‐cause mortality over the follow‐up period was 32.9% in the amiodarone group compared with 29.6% in those not on amiodarone ( P =0.008). Similar results were noted in the propensity‐matched group (log‐rank, P =0.04). On multivariable Cox regression analysis, amiodarone use at baseline was independently associated with all‐cause mortality (hazard ratio, 1.68 [95% CI, 1.1–2.5]; P =0.01). Conclusions Amiodarone use was associated with significantly increased rates of all‐cause mortality in CF‐LVAD recipients. Earlier interventions for arrhythmias to avoid long‐term amiodarone exposure may improve long‐term outcomes in CF‐LVAD recipients and needs further study.

BACKGROUND Limited data exist regarding complication rates of implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy devices (CRT-D) in patients with left ventricular assist devices (LVAD). OBJECTIVE We describe the incidence and characteristics of ICDand CRT-D-related procedures and complications in a multicenter LVAD cohort. METHODS A total of 537 LVAD patients with a pre-existing ICD or CRT-D from 5 centers were included. Details on device type, device therapies, procedural complications, and long-term survival were analyzed. RESULTS Of 537 patients, 280 had a CRT-D and 257 had ICD only. During a median follow-up of 538 days, 126 patients underwent generator replacement with significantly higher rate in the CRT group (79 [28.2%] vs 47 [18.3%], P = .0006). Device-related complications occurred in 36 (13%) CRT-D and 20 (8%) ICD patients (P = .06). Incidence of pocket hematoma (3.2% vs 2.7%), infection (4.3% vs 1.6%), and lead malfunction (3.1% vs 2.8%) was similar in both groups, with no effect of device complication on longterm survival (log-rank P 5.7). There was a higher incidence of post-LVAD antitachycardia pacing for ventricular arrhythmias in the CRT-D group compared to the ICD group (35% vs 26%, P5.03). CONCLUSION Cardiac implantable electronic device-related procedures are common in LVAD patients. Compared to ICD only, continued CRT-D therapy post-LVAD results in a significantly higher number of generator changes and a trend towards higher device- or lead-related complications. Device-related complications were not associated with reduced survival.

Cardiac resynchronization therapy (CRT) improves outcomes in heart failure patients with wide QRS complex. However, CRT management following continuous flow Left Ventricular Assist Device (LVAD) implant vary: some centers continue CRT while others turn off the left ventricular (LV) lead at LVAD implant. We sought to study the effect of continued CRT versus turning off CRT pacing following continuous flow LVAD implantation. A comprehensive retrospective multicenter cohort of 295 patients with LVAD and pre-existing CRT was studied. CRT was programmed off after LVAD implant in 44 patients. We compared their outcomes to the rest of the cohort using univariate and multivariate models. Mean age was 60 ± 12 years, 83% were males, 52% had ischemic cardiomyopathy and 54% were destination therapy. Mean follow-up was 2.4 ± 2.0 years, and mean LVAD support time was 1.7 ± 1.4 years. Patients with CRT OFF had a higher Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) mean profile (3.9 vs 3.3, p = 0.01), more secondary prevention indication for a defibrillator (64.9% vs 44.5%, p = 0.023), and more pre-LVAD ventricular arrhythmias (VA) (77% vs 60%, p = 0.048). There were no differences between the CRT OFF and CRT ON groups in overall mortality (Log rank p = 0.32, adjusted HR = 1.14 [0.54–2.22], p = 0.71), heart transplantation, cardiac and noncardiac mortality, all cause hospitalizations, hospitalizations for ICD shocks, and number and frequency of ICD shocks or anti-tachycardia pacing therapy. There were no differences in post LVAD atrial arrhythmias (AA) (Adjusted OR = 0.45 [0.18–1.06], p = 0.31) and ventricular arrhythmias (OR = 0.65 [0.41–1.78], p = 0.41). There was no difference in change in LVEF, LV end diastolic and end systolic diameters between the 2 groups. Our study suggests that turning off CRT pacing after LVAD implantation in patients with previous CRT pacing did not affect mortality, heart transplantation, device therapies or arrhythmia burden. A prospective study is needed to confirm these findings.

Background While clinical experience with left ventricular assist devices (LVAD) continues to grow and evolve, little is known regarding the ongoing use of certain medications in this population. We sought to evaluate the utility of digoxin in LVAD recipients and its association with outcomes. Methods A total of 505 patients who underwent continuous-flow LVAD implantation at 5 centers from 2007-2015 were included. Patients were divided into 4 groups: not on digoxin at any time (ND; n = 257), received digoxin pre implant (PreD; n = 144), received digoxin pre and post implant (ContD; n = 55), and received digoxin only post implant (PostD; n = 49). Survival and all-cause readmission were compared between the 4 groups. Results There was no difference in survival at 1 year nor at 3 years between groups (ND = 88%, 66%, respectively; PreD = 85%, 66%; ContD = 86%, 57%; PostD = 90%, 51%; p = 0.7). Readmission per 100 days also was not different between groups (ND = 0.5, PreD = 0.6, ContD = 0.5, PostD = 0.7; p = 0.1). Conclusions In this large, multicenter cohort, use of digoxin was not associated with any significant benefit in regard to mortality or hospitalization in patients supported with a continuous-flow LVAD. Importantly, its discontinuation post implant did not worsen all-cause hospitalization or survival.

Introduction: Use of continuous flow left ventricular assist devices (CFVAD) have substantially increased. Ventricular arrhythmias are common following VAD implant and can result in ICD shocks. Hyp...

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.

Background Many patients with heart failure continue cardiac resynchronization therapy (CRT) after continuous flow left ventricular assist device (CF‐LVAD) implant. We report the first multicenter study to assess the impact of CRT on clinical outcomes in CF‐LVAD patients. Methods and Results Analysis was performed on 488 patients (58±13 years, 81% male) with an implantable cardioverter defibrillator (ICD) (n=223) or CRT‐D (n=265) who underwent CF‐LVAD implantation at 5 centers from 2007 to 2015. Effects of CRT on mortality, hospitalizations, and ventricular arrhythmia incidence were compared against CF‐LVAD patients with an ICD alone. Baseline differences were noted between the 2 groups in age (60±12 versus 55±14, P<0.001) and QRS duration (159±29 versus 126±34, P=0.001). Median biventricular pacing in the CRT group was 96%. During a median follow‐up of 478 days, Kaplan–Meier analysis showed no difference in survival between groups (log rank P=0.28). Multivariate Cox regression demonstrated no survival benefit with type of device (ICD versus CRT‐D; P=0.16), whereas use of amiodarone was associated with increased mortality (hazard ratio 1.77, 95% confidence interval 1.1–2.8, P=0.01). No differences were noted between CRT and ICD groups in all‐cause (P=0.06) and heart failure (P=0.9) hospitalizations, ventricular arrhythmia incidence (43% versus 39%, P=0.3), or ICD shocks (35% versus 29%, P=0.2). During follow‐up, 69 (26%) patients underwent pulse generator replacement in the CRT‐D group compared with 36 (15.5%) in the ICD group (P=0.003). Conclusions In this large, multicenter CF‐LVAD cohort, continued CRT was not associated with improved survival, hospitalizations, incidence of ventricular arrhythmia and ICD therapies, and was related to a significantly higher number of pulse generator changes.

IMPORTANCE There is a genetic predisposition to early-onset atrial fibrillation (EOAF) in European American individuals. However, the role of family history in the pathogenesis of EOAF in racial and ethnic minorities remains unclear. OBJECTIVE To determine whether probands with EOAF across racial and ethnic groups have a higher rate of AF in first-degree family members than racially and ethnically matched control patients with non-early-onset AF (non-EOAF). DESIGN, SETTING, AND PARTICIPANTS In this cohort study, patients prospectively enrolled in a clinical and genetic biorepository were administered baseline questionnaires that included questions about family history of AF. Early-onset AF was defined as AF occurring in probands aged 60 years or younger in the absence of structural heart disease. All other forms were categorized as non-EOAF. Recruitment took place from July 2015 to December 2017. Analysis was performed in January 2018. MAIN OUTCOMES AND MEASURES Primary analysis of reported family history of AF in first-degree relatives with sensitivity analysis restricted to those in whom a family history was confirmed by medical record review and electrocardiogram. RESULTS Of 664 patients enrolled (mean [SD] age, 62 [12] years; 407 [61%] male), 267 (40%) were European American; 258 (39%). African American; and 139 (21%), Hispanic/Latino. There was a family history of AF in 36 probands with EOAF (49%) compared with 128 patients with non-EOAF (22%) (difference. 27%; 95% CI, 14%-40%; P < .001). On multivariable analysis, the adjusted odds of a proband with EOAF who was of African descent (odds ratio [OR], 2.69; 95% CI, 1.06-6.91: P < .001) or Hispanic descent (OR, 9.25; 95% CI, 2.37-36.23; P = .002) having a first-degree relative with AF were greater than those of European descent (OR, 2.51; 95% CI, 1.29-4.87; P = .006). Overall, probands with EOAF were more likely to have a first-degree relative with AF compared with patients with non-EOAF (adjusted OR, 3.02; 95% CI, 1.82-4.95; P < .001) across the 3 racial and ethnic groups. Atrial fibrillation in a first-degree family member was confirmed in 32% of probands with EOAF vs 11% of those with non-EOAF (difference, 21%; 95% CI, 11%-33%; P < .001). Furthermore, African American (28% vs 5%; difference, 23%; 95% CI, 4%-43%; P = .001), European American (35% vs 20%; difference, 15%; 95% CI, 1%-30%; P = .03), and Hispanic/Latino (30% vs 5%; difference, 25%; 95% CI, 4%-54%; P = .02) probands with EOAF were more likely to have a first-degree relative with confirmed AF vs racially and ethnically matched control patients with non-EOAF. The positive and negative predictive values for a family history of confirmed AF were both 89%. CONCLUSIONS AND RELEVANCE Probands of African or Hispanic/Latino descent with EOAF were more likely to have a first-degree relative with AF when compared with European American individuals. These findings support genetic predisposition to EOAF across all 3 races.

Due to various metabolic and neurohormonal derangements in the syndrome of advanced heart failure, preoperative assessment in patients requiring left ventricular assist device (LVAD) placement is challenging. Psoas muscle diameter (PMD) can be easily measured in CT images of the abdomen, and has been shown to be a reliable indicator of nutritional and functional status in surgical and oncologic patients. The neutrophil to lymphocyte ratio (NLR) is an established marker for inflammatory status and has been shown to be predictive of postoperative outcomes in LVAD patients.

Digoxin is one of the oldest medications used to improve symptoms and decrease hospitalization in patients with heart failure. However, several recent investigations have demonstrated that digoxin use may not be beneficial, and in certain instances may also increase arrhythmia burden as well as be associated with worse survival. Despite an increased awareness of the negative associations of digoxin use and outcomes, it continues to be included in current guideline recommendations for the treatment of systolic heart failure. As such, many patients who ultimately receive left ventricular assist devices (LVAD) are maintained on this medication pre-implant. In this multicenter study we sought to examine digoxin utilization and its impact on survival in LVAD recipients.

Introduction: Patients with continuous flow Left Ventricular Assist Devices (LVAD) and concomitant Cardiac Implantable Electrical Devices (CIED) are prone for device and lead-related complications requiring intervention. Hypothesis: We evaluated the incidence and characteristics of CIED-related procedures and complications and their association with survival in a multicenter LVAD cohort. Methods: We retrospectively reviewed data on 480 LVAD patients with a CIED from 5 centers. Of the 480, 235 patients had accurate long-term CIED follow-up data and were used for this analysis. Kaplan Meier analysis was used to assess survival differences between patients with CIED-related complications versus those who did not. Results: Of 235 patients with an LVAD and a CIED (Age 58±13, 80% male), 130 had a CRT-D and 105 had ICD only. During a median LVAD follow-up of 692 days, 103 patients required a CIED generator replacement with CRT-D patients having a significantly higher rate of generator replacement compared to the ICD only group (68[52%] vs 35[33%], p=0.003). A CIED or lead-related complication occurred in 36 (28%) of CRT-D patients and 16 (15%) of the ICD patients (p=0.06). 20 (15%) patients in the CRT-D group and 14 (13%) in the ICD group underwent lead removal or extraction during follow-up (p=0.5). Both the CRT-D and ICD groups had comparable incidences of pocket hematoma (8% vs 5%), pocket and/or lead infection (9% vs 4%), and lead malfunction (8% vs 9%). Kaplan Meier analysis showed no significant survival difference between those who had a CIED-related complication versus those who did not (log rank p= 0.7). Conclusions: CIED related procedures are common in LVAD patients. Compared to ICD only, continued CRT-D post-LVAD resulted in a significantly higher number of generator changes and showed a trend towards higher device or lead related complications. CIED-related complications were not associated with reduced survival.

Introduction: After successful catheter ablation (CA) for typical atrial flutter (AFL), long term development of atrial fibrillation (AF) is common. No definitive predictive models currently exist to identify patients who are likely to develop AF. The aim of this study was to evaluate whether CHA 2 DS 2 VASc score can predict future occurrence of AF after successful CA of AFL. Methods: We conducted a retrospective chart review of 171 consecutive patients with isolated AFL who underwent successful CA between years 2007-2014 at a teaching community hospital. Patients with at least 2 years of follow-up were included for analysis. 40 patients were lost to follow-up. CHA 2 DS 2 VASc scores were calculated at the time of CA. Follow up consisted of in-office electrocardiograms, and (when available) in-office and remote device interrogation. Patients were anticoagulated at the discretion of their treating physician. The endpoint was time to first occurrence of AF. Data was analyzed using appropriate descriptive and univariate statistics to describe, compare and contrast based upon AF occurrence groups. A cox regression was performed to examine CHA 2 DS 2 VASc score as a predictor of AF occurrence during CA follow-up. Results: 131 patients were included in the study. Average age was 66 ±11.5 years and follow-up duration was 26.6±1.5 months. AF occurred in 52 patients (39.7%) by 2 years. Patients who developed AF had a CHA 2 DS 2 VASc score of 3.4±1.4, compared to 2.6±1.3 for patients who did not (p < 0.003). Patients who developed AF were also older (70.2±10.3 vs. 63.7±11.6 years, p<.001,), and had a higher rate of Hypertension (3.40±1.35 vs. 2.6±1.3, p=.037,). CHA 2 DS 2 VASc score was found to be significantly associated with AF onset during the 2 year follow-up (p<.007, Hazard Ratio 1.36, 95%CI 1.09-1.70). Conclusion: The incidence of AF following CA of AFL is common. CHA 2 DS 2 VASc score may be a useful tool and predictor of AF after typical AFL ablation. This needs to be evaluated further in larger randomized trials which may help in guiding long term anticoagulation therapy.