Impact of Atrial Fibrillation on Outcomes after Left Ventricular Assist Device Implantation: Systematic Review and Meta-Analysis

Background: Atrial fibrillation (AF) is a common finding in patients with heart failure and is well-known for its deleterious effects on cardiac function and hemodynamics; however, there are gaps in knowledge regarding the impact of AF on patients with left ventricular assist devices (LVADs). Methods: In this study, we searched PubMed/Medline, Embase, and Cochrane Library databases through September 2021 to find articles that assessed the outcomes of AF in patients with LVADs. Results: A total of 12 studies that underwent systematic review evaluated the outcomes of 7853 adult patients. The meta-analysis analyzed findings from a total of 1003 patients. Pooled findings indicated a 25% higher risk of mortality in patients with AF as compared to those in sinus rhythm (P = .02). No statistically significant differences in mortality were noted between patients with paroxysmal AF or persistent AF (P = .13). No statistically significant differences were noted between the groups in terms of bleeding (P = .70). There was an increased risk of thromboembolism in patients with sinus rhythm compared to those with AF (P < .001). Conclusion: The presence of AF was not found to be associated with an increased risk of bleeding or thromboembolism but may be associated with increased mortality.