VT-LVAD score ≥5 identified patients with higher early ventricular arrhythmia incidence (91% vs. 43%, p<0.001), but no significant difference in long-term mortality (37.0% vs. 21.7%, p=0.59) or arrhythmic events.
Observational (n=63)
No
Does the VT-LVAD score predict early and long-term ventricular arrhythmias and mortality in patients with continuous-flow left ventricular assist devices and ICDs?
The VT-LVAD score effectively identifies patients at high risk for early postoperative ventricular arrhythmias after CF-LVAD implantation, but it does not predict long-term arrhythmic events or mortality.
Effect estimate: p < 0.001 for VA incidence in hospital
Absolute Event Rate: 91% vs 43%
p-value: p=<0.001
Background 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. Methods 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. Results 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. Conclusion 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.
Fish et al. (2026) conducted an observational in Adults (mean age ~60 years) implanted with primary continuous-flow left ventricular assist device (CF-LVAD) and receiving implantable cardioverter-defibrillator (ICD) therapy (n=63). ICD implantation with VT-LVAD score risk stratification vs. Low/intermediate risk VT-LVAD score (<5) vs. high/very high risk (≥5) was evaluated on Incidence of early postoperative ventricular arrhythmias (VAs) and long-term mortality and arrhythmic events (p < 0.001 for VA incidence in hospital, p=<0.001). VT-LVAD score ≥5 identified patients with higher early ventricular arrhythmia incidence (91% vs. 43%, p<0.001), but no significant difference in long-term mortality (37.0% vs. 21.7%, p=0.59) or arrhythmic events.