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L Gilge J, Ahmed A, A Clark B, Morris K, Yavar Z, Beaudrie N, Whitler C, Husain M, S Padanilam M, J Patel P, N Prystowsky E, K Ravichandra A. Rate Control Versus Rhythm Control in Patients with Left Ventricular Assist Devices and Atrial Fibrillation. J Atr Fibrillation 2021; 13:20200474. [PMID: 34950354 DOI: 10.4022/jafib.20200474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/15/2020] [Accepted: 07/25/2020] [Indexed: 11/10/2022]
Abstract
Background Atrial fibrillation (AF) is a common comorbidity in patients with left ventricular assist devices (LVAD) with no defined guideline treatment strategy of rate versus rhythm control. The purpose of this study is to determine the effects of rate versus rhythm control for AF on the outcomes of patients with LVAD at our institution. Methods Consecutive patients who underwent LVAD implantation at St Vincent Hospital from January 1, 2015 to December 31, 2017 were retrospectively evaluated. Patients with AF were identified and divided into rate control or rhythm control groups. The primary outcome evaluated was a composite of death, heart failure admission, gastrointestinal bleed, ventricular tachycardia, cerebrovascular accident, hemolysis, and pump thrombosis. Secondary outcomes included the individual variables from the primary outcome. Results Out of 201 patients that underwent LVAD implantation, 81 had AF after implantation and were included with a median follow-up period of 384 days. The rate control group (n = 31; 38%) and the rhythm control group (n = 51; 62%) had no difference in composite outcomes (61% vs 59%, p = 0.83). When taken individually there was no difference in outcomes between the two groups. Thirteen patients underwent electrical cardioversion and successful conversion to normal sinus rhythm occurred in 71% of cases with a 60% recurrence rate. Conclusions There was no difference in primary outcome between rate and rhythm control groups. These data suggest that maintenance of sinus rhythm may not be necessary in all patients with LVAD.
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Affiliation(s)
- Jasen L Gilge
- All authors are from Ascension St Vincent, 8333 Naab Road, #400, Indianapolis, IN 46260
| | - Asim Ahmed
- All authors are from Ascension St Vincent, 8333 Naab Road, #400, Indianapolis, IN 46260
| | - Bradley A Clark
- All authors are from Ascension St Vincent, 8333 Naab Road, #400, Indianapolis, IN 46260
| | - Kathleen Morris
- All authors are from Ascension St Vincent, 8333 Naab Road, #400, Indianapolis, IN 46260
| | - Zubin Yavar
- All authors are from Ascension St Vincent, 8333 Naab Road, #400, Indianapolis, IN 46260
| | - Nicolas Beaudrie
- All authors are from Ascension St Vincent, 8333 Naab Road, #400, Indianapolis, IN 46260
| | - Cameron Whitler
- All authors are from Ascension St Vincent, 8333 Naab Road, #400, Indianapolis, IN 46260
| | - Mahera Husain
- All authors are from Ascension St Vincent, 8333 Naab Road, #400, Indianapolis, IN 46260
| | - Mathew S Padanilam
- All authors are from Ascension St Vincent, 8333 Naab Road, #400, Indianapolis, IN 46260
| | - Parin J Patel
- All authors are from Ascension St Vincent, 8333 Naab Road, #400, Indianapolis, IN 46260
| | - Eric N Prystowsky
- All authors are from Ascension St Vincent, 8333 Naab Road, #400, Indianapolis, IN 46260
| | - Ashwinn K Ravichandra
- All authors are from Ascension St Vincent, 8333 Naab Road, #400, Indianapolis, IN 46260
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