Meta-Analysis of the Effect of Preoperative Atrial Fibrillation on Outcomes After Left Ventricular Assist Device Implantation.

Affiliation

Internal Medicine, John H Stroger Jr Hospital of Cook County, Chicago, Illinois. Electronic address: [Email]

Abstract

The effect of preoperative atrial fibrillation (AF) on clinical outcomes after left ventricular assist device (LVAD) implantation remains uncertain. We sought to conduct a meta-analysis to assess the safety and efficacy of LVAD implantation in AF patients. Medline and Scopus were searched for studies that assessed the effect of preoperative AF on clinical outcomes in patients who underwent LVAD implantation. Outcomes of interest included all-cause mortality, thromboembolic events, and bleeding. Estimates were combined using random effects model to calculate risk ratios (RRs) with 95% confidence intervals. In this meta-analysis of 7 studies including 5,658 patients, preoperative AF was not associated with increased risk of all-cause mortality at 30 days (RR = 0.84 [0.51, 1.37]; p = 0.49; I2 = 0%), 6 months (RR = 1.17 [0.96, 1.14]; p = 0.11; I2 = 21%), 1 year (RR = 1.16 [0.84, 1.60]; p = 0.37; I2 = 53%) and 2 years (RR = 1.14 [0.96, 1.36]; p = 0.12; I2 = 23%). Preoperative AF did not increase the risk of thromboembolism (RR = 0.86 [0.38, 1.92]; p = 0.71; I2 = 26%), pump thrombosis (RR = 1.22 [0.88, 1.68]; p = 0.23; I2 = 49%), stroke (RR = 1.02 [0.87, 1.19]; p = 0.79; I2 = 11%), or major bleeding (RR = 0.86 [0.38, 1.92]; p = 0.71; I2 = 26%) after LVAD implantation. However, AF was associated with significantly increased risk of gastro-intestinal bleeding in patients receiving LVADs (RR = 1.27 [1.05, 1.55]; p = 0.014; I2 = 0%). In conclusion, this meta-analysis reports a significantly increased risk of gastrointestinal (GI) bleeding in LVADs recipients having concomitant AF. However, AF had no significant effect on all-cause mortality, stroke, or thromboembolic events in these patients. Further well-conducted studies are needed to validate these results.