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Open Access Publications from the University of California

Scholarly Works (2 results)

  • Article
  • Peer Reviewed
UC San Diego Previously Published Works (2018)

For patients with end-stage heart failure, the use of mechanical circulatory support has increased in the last decade due to improved outcomes with durable left ventricular assist devices. The management of these complex patients requires coordinated care by a multidisciplinary team including cardiac electrophysiologists because atrial and ventricular arrhythmias are prevalent in this population. There have been an increasing number of studies that attempt to address issues regarding arrhythmia management in patients with left ventricular assist devices. The purpose of this review is to provide electrophysiologists with an evidence-based approach to manage a broad spectrum of arrhythmia issues in these patients.

    Cover page: Management of Arrhythmias and Cardiac Implantable Electronic Devices in Patients With Left Ventricular Assist Devices.
    • Article
    • Peer Reviewed
    UC San Diego Previously Published Works (2020)
    Left ventricular assist devices (LVADs) have dramatically improved short-term outcomes among patients with advanced heart failure. While neurohormonal blockade (NHB) is the cornerstone of treatment for patients with heart failure with reduced ejection fraction, its effect after LVAD placement has not been established. We reviewed medical records of 307 patients who underwent primary LVAD implantation from January 2006 to September 2015 at two institutions in the United States. Patients were followed for at least 2 years post-LVAD implantation or until explantation, heart transplantation, or death. Cox regression analysis stratifying on center was used to assess associations with mortality. Neurohormonal blockade use was treated as a time-dependent predictor. Stepwise selection indicated treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) (hazard ratio [HR] = 0.53 [0.30-0.95], p = 0.03), age at the time of implantation (HR = 1.28 [1.05-1.56] per decade, p = 0.02), length of stay postimplantation (HR = 1.16 [1.11-1.21] per week, p < 0.01) and INTERMACS profile of 1 or 2 (HR = 1.86 [1.17-2.97], p < 0.01) were independent predictors of mortality. In this large, retrospective study, treatment with ACEIs or ARBs was an independent factor associated with decreased mortality post-LVAD placement.
      Cover page: Benefits of Neurohormonal Therapy in Patients With Continuous-Flow Left Ventricular Assist Devices.
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