What is the clinical evidence from this study?

Study design: Observational. Population: Sudden cardiac death (n=109). Intervention: Cardiac arrhythmias. Primary outcome: Hospital survival.

March 31, 2021Journal of Clinical Medicine3 citationsOpen Access

Cardiac Arrhythmias in Survivors of Sudden Cardiac Death Requiring Impella Assist Device Therapy

KAKhaled Q. A. AbdullahKliniken Maria Hilf JRJana V. RoedlerKliniken Maria Hilf JDJuergen vom DahlKliniken Maria Hilf

Key Result

Cardiac arrhythmias were frequent during Impella support for sudden cardiac death survivors but did not predict hospital mortality, which was 83.5% overall.

Study Design

Type

Observational (n=109)

Multicenter

Structured PICO

Do cardiac arrhythmias predict hospital mortality in survivors of sudden cardiac death requiring Impella assist device therapy?

Population

109 consecutive patients (median age 69 years, 27.5% female) who survived sudden cardiac death and required Impella assist device therapy between 2008 and 2018.

Exposure

Impella assist device therapy with continuous rhythm monitoring.

Outcome

Hospital survival / mortalityhard clinical

In survivors of sudden cardiac death requiring Impella support, cardiac arrhythmias are highly frequent but do not predict hospital mortality, suggesting the mechanical hemodynamic support may counterbalance the adverse effects of these arrhythmias.

Abstract

In this retrospective single-center trial, we analyze 109 consecutive patients (female: 27.5%, median age: 69 years, median left ventricular ejection fraction: 20%) who survived sudden cardiac death (SCD) and needed hemodynamic support from an Impella assist device between 2008 and 2018. Rhythm monitoring is investigated in this population and associations with hospital survival are analyzed. Hospital mortality is high, at 83.5%. Diverse cardiac arrhythmias are frequently registered during Impella treatment. These include atrial fibrillation (AF, 21.1%) and ventricular tachycardia (VT, 18.3%), as well as AV block II°/III° (AVB, 7.3%), while intermittent asystole (ASY) is the most frequently observed arrhythmia (42.2%). Nevertheless, neither ventricular nor supraventricular tachycardias are associated with patients’ survival. In patients who experience intermittent asystole, a trend towards a fatal outcome is noted (p = 0.06). Conclusions: Mortality is high in these severely sick patients. While cardiac arrhythmias were frequent, they did not predict hospital mortality in this population. The hemodynamic support of the pump seems to counterbalance the adverse effects of these events.

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