Impact of Age and Left Atrial Remodeling in Patients with Atrial Fibrillation Undergoing Left Ventricular Assist Device Implantation

Objective Patients with advanced heart failure (AHF) undergoing left ventricular assist device have a high prevalence of atrial arrhythmias. Moreover, patients with AHF have significant left atrial remodeling that increases their risk for mortality. The objective of this study was to evaluate the impact of left atrial volume index (LAVI) on mortality in LVAD patients with atrial fibrillation (AF). Methods A total of 159 consecutive patients undergoing LVAD implantation were analyzed retrospectively. Median follow up was for 2.0 years. Electronic medical records, electrocardiograms, echocardiograms, and invasive hemodynamics were reviewed. The associations of AF and LAVI with all-cause mortality were examined using Kaplan-Meier survival analysis and Cox proportional hazard regression. Results We measured LAVI size in those with and without AF. LAVI size was categorized into small or large based on a median value of 54.1 ml/m2. Patients with AF/Large LAVI were older, had higher prevalence of diabetes, larger end diastolic dimension, larger end diastolic volume and significant valvular heart disease compared to no AF/small LAVI group. (Table). Survival estimate showed increased mortality in those with AF/large LAVI compared to those with no AF/small LAVI (p<0.037) (Figure). Univariate analysis showed that age (RR: 1.037, 95%CI:1.008-1.068, p=0.012) and LAVI (RR: 1.016, 95% CI:1.002-1.030, p=0.026) were the only predictors for mortality. After multivariate analysis however, only age (age-RR: 1.039, 95% CI:1.004-1.075, p=0.027 vs. LAVI-RR: 1.004, 95% CI:0.987-1.022, p=0.653) was determined to be a predictor of mortality. Conclusions LVAD patients with history of atrial fibrillation and large LAVI size are at higher risk for mortality, however this effect may be attributable to older age rather than changes in left atrial remodeling and presence of AF.