Impact of QRS Duration and Ventricular Pacing on Clinical and Arrhythmic Outcomes in Continuous Flow Left Ventricular Assist Device Recipients: A Multicenter Study.

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Journal of cardiac failure


AIMS: Wide QRS duration and ventricular pacing are common in continuous flow left ventricular assist device (CFLVAD) recipients but their impact on outcomes remains unclear. We assessed the clinical and arrhythmic outcomes of CFLVAD patients with wide QRS or right ventricular (RV) pacing at baseline, when compared to narrow QRS or continued cardiac resynchronization therapy (CRT).

METHODS AND RESULTS: 520 patients (57±13 years) with an ICD (n=240) or CRT-D (n=280) who underwent CFLVAD implantation at 5 centers from 2007-2015 were studied. Patients were divided into 3 groups: ICD-N (QRS ≤ 120 msec; n=134), ICD-W (QRS >120 msec; n=106) and c) CRT (n=280). Mortality, hospitalization, and ventricular (VA) arrhythmia incidence were compared between groups. Baseline QRS duration was different between groups (100±13 [ICD-N] vs 155±26 [ICD-W] vs 159±29 msec [CRT], p < 0.0001). In ICD-W group, 37 (35%) had >80% RV pacing at baseline. Median biventricular pacing in CRT group was 96%. Over 523 days of CFLVAD support, Kaplan-Meier analysis showed no difference in survival between groups (Log rank p = 0.9). By multivariate Cox regression, wide QRS duration and RV pacing were not associated with survival. QRS narrowed during CFLVAD support in ICD-W and CRT groups but was not associated with improved survival (p = 0.9). No differences were noted between groups in hospitalizations (p = 0.9), VA (p = 0.2), or ICD shocks (p = 0.06).

CONCLUSION: In this large CFLVAD cohort, a wide QRS duration and high percentage RV pacing at baseline as well as changes in QRS duration post-LVAD were not associated with survival. Continued CRT following CFLVAD implant was also not associated with improved survival or HF hospitalizations.

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ePub ahead of print