# Implantable cardioverter-defibrillator use in patients with left ventricular assist device: prediction of ventricular arrhythmia using the VT-LVAD score

## TL;DR

This study explores whether a risk score called VT-LVAD can help identify heart patients who may benefit from an ICD after a left ventricular assist device implant.

## Contribution

The study evaluates the VT-LVAD score's ability to predict early ventricular arrhythmias in LVAD patients and assesses ICD-related complications.

## Key findings

- Patients with a VT-LVAD score ≥5 had a higher rate of in-hospital ventricular arrhythmias compared to those with a score <5.
- Long-term mortality and arrhythmic events were similar between the two risk groups.
- ICD therapy did not show a survival benefit in this patient population.

## Abstract

The survival benefit of implantable cardioverter-defibrillators (ICD) in patients with left ventricular assist device (LVAD) remains unproven. The VT-LVAD score was developed to stratify arrhythmic risk and may help identify patients most likely to benefit from ICD therapy. We aimed to retrospectively assess its ability to identify patients at higher risk of ventricular arrythmias and to describe ICD-related complications in a population of patients with ICD and LVAD.

A total of 63 primary continuous-flow LVAD implantation were performed at our institution between January 2010 and March 2020 were included and stratified by risk (VT-LVAD score <5 or ≥5). Thirty patients (47.6%) had a low/intermediate risk VT-LVAD score (<5) (Group 1) and 33 (52.4%) a high/very high-risk VT-LVAD (score ≥5) (Group 2). Patients either had a previous ICD or were implanted before discharge, unless transplanted urgently. Early postoperative outcomes, including in-hospital arrhythmic events with hemodynamic instability, were collected, along with long-term outcomes such as all-cause mortality, ICD therapies, and ICD-related complications.

Patients with a VT-LVAD score ≥5 were more likely to experience in-hospital ventricular arrhythmias (VAs) than those with score <5 (91% vs. 43%, p < 0.001). These VAs occurred mainly in the first five postoperative days, often due to an underlying cause, and resulted in hemodynamic instability in 40% of VT-LVAD <5 patients vs. 50% in VT-LVAD ≥5 (p = 0.44). Long-term mortality was similar for VT-LVAD <5 and ≥5 respectively (21.7% vs. 37.0%, p = 0.59) and there was no difference in arrhythmic events, including ATP therapies (17% vs. 22%, p = 0.73) and appropriate (0% vs. 4%) or inappropriate shocks (9% vs. 11%). There was one early lead dislodgement requiring repositioning, but no other long-term ICD complications.

The findings of our study are exploratory and hypothesis-generating; while the VT-LVAD score identifies patients at higher early arrhythmic risk, long-term malignant VAs were rare in both groups, and no survival benefit of ICD therapy can be derived from this study.