Ventriculaire aritmieën na LVAD-implantatie: meta-analyse

AIMS: Ventricular arrhythmias (VAs) occur frequently following left ventricular assist device (LVAD) implantation. However, current evidence regarding their true incidence and impact remains limited. METHODS AND RESULTS: We performed a systematic review and meta-analysis to assess the incidence and impact of post-LVAD VAs. PubMed/Embase/Cochrane databases were searched from inception to 1 April 2025, for studies reporting the occurrence of VAs following LVAD implantation. The primary outcome was the overall incidence of VAs. Secondary outcomes included the incidence of early (≤30 days) and late (>30 days) VAs, as well as electrical storm (ES) and their impact on all-cause mortality, assessed using incidence rate ratios (IRRs). Forty studies including 22 181 patients were analysed. The overall incidence of post-LVAD VAs was 2.43 (1.70-3.48) events per 100 person-months. Ventricular arrhythmia occurrence was significantly associated with increased all-cause mortality [IRR 1.32 (1.11-1.57)). The incidence of early VAs was 0.65 (0.48-0.88) events per 100 person-days (19.5 events per 100 patients over 30 days), and early VAs were associated with a higher risk of mortality [IRR 1.40 (1.18-1.67)]. Conversely, the incidence of late VAs was 2.05 (1.43-2.93) events per 100 person-months and was not significantly associated with mortality [IRR 0.85 (0.66-1.10)]. Electrical storm incidence was 0.44 (0.07-2.71) events per 100 person-months, significantly increasing all-cause mortality [IRR 1.34 (1.01-1.79)]. CONCLUSION: Ventricular arrhythmias are frequent following LVAD implantation and are associated with a significant impact on all-cause mortality-particularly when occurring early after implantation. Further studies are needed to optimize VA management and implantable cardioverter-defibrillator use.