Concerns Regarding “Echocardiographic Predictors of Ventricular Arrhythmias in Patients with Left Ventricular Assist Devices and Implantable Cardioverter‐Defibrillator”

Concerns Regarding “Echocardiographic Predictors of Ventricular Arrhythmias in Patients with Left Ventricular Assist Devices and Implantable Cardioverter‐Defibrillator” | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 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Data may be preliminary. 4 March 2025 V1 Latest version Share on Concerns Regarding “Echocardiographic Predictors of Ventricular Arrhythmias in Patients with Left Ventricular Assist Devices and Implantable Cardioverter‐Defibrillator” Authors : Muhammad Javed 0009-0001-6516-4052 and Muneeb Khawar 0009-0005-7051-7413 Authors Info & Affiliations https://doi.org/10.22541/au.174109881.10671099/v1 Published Journal of Cardiovascular Electrophysiology Version of record Peer review timeline 287 views 211 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract 4o This letter to the editor critiques the study on echocardiographic predictors of ventricular arrhythmias (VAs) in left ventricular assist device (LVAD) patients with pre-existing implantable cardioverter defibrillators (ICDs). While the study provides robust statistical analysis, its findings may not be generalizable to LVAD patients without ICDs. Additionally, the reliance on echocardiography alone limits the assessment of arrhythmic risk, as cardiac MRI with late gadolinium enhancement (LGE) could better evaluate myocardial fibrosis. The study also lacks data on antiarrhythmic therapy, which may influence post-LVAD VA incidence. Future research should incorporate advanced imaging, electrophysiological mapping, and pharmacologic strategies to refine risk prediction and improve patient outcomes. Concerns Regarding “Echocardiographic Predictors of Ventricular Arrhythmias in Patients with Left Ventricular Assist Devices and Implantable Cardioverter‐Defibrillator” Authors: Muhammad Nouman Javed MBBS1, Muneeb Khawar MBBS2, Javed Iqbal RN, CHN, MHA3. 1. Department of Cardiology, Faisalabad Medical University, Faisalabad, Pakistan 2. Department of Cardiology, King Edward Medical University, Lahore, Pakistan 3. Department of Nursing, Hamad Medical Corporation, Doha, Qatar Email address Muhammad Nouman Javed: [email protected] Muneeb Khawar: [email protected] Javed Iqbal: [email protected] Corresponding Author: Javed Iqbal Nursing Department, Communicable Disease Center Hamad Medical Corporation, Doha, Qatar, P.O Box 3050 Email: [email protected] ORCID: 0000-0003-2627-685X Telephone: +974 5595 1635 Acknowledgement Data Availability Statement: All data referenced in this letter are publicly available in the original publication and cited sources. No new data was generated or analyzed in the preparation of this letter. Funding Statement: No funding was received for the preparation or submission of this letter. Ethics Approval Statement: As this is a commentary on a published study and no new data were collected or analyzed, ethics approval was not required. Dear Editor, I am writing to express my concerns regarding the study “Echocardiographic Predictors of Ventricular Arrhythmias in Patients with Left Ventricular Assist Devices and Implantable Cardioverter‐Defibrillator” published in the Journal of Cardiovascular Electrophysiology 1 . This research gives an analytical perspective on the predictive role of preoperative echocardiography markers of ventricular arrhythmias (VAs) in patients who have preexisting implantable cardioverter defibrillator (ICD) undergoing left ventricular assist device (LVAD) implantation. However, I would like to highlight some important research gaps and limitations of this study that warrant further discussion. The strength of the article is the robust statistical analysis that analyzes echocardiographic predictors of VAs after LVAD with Cox regression models, Kaplan-Meier survival curves, and univariate and multivariate regression analysis 1 . However, it is confined to patients with pre-existing ICDs, so the findings cannot be extrapolated easily to LVAD patients without ICDs and possibly with unrecognized self-terminating arrhythmias. A previous study tries to measure arrhythmia burden in LVAD patients without ICDs with the help of implantable cardiac monitors (ICMs) 2 . Furthermore, this study relies solely on echocardiography. It lacks the use of advanced imaging techniques such as cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement (LGE) which may provide a broader evaluation of myocardial fibrosis as an arrhythmogenic substrate. An earlier study considers LGE as a predictor of late ventricular arrhythmias in patients who underwent LVAD and finds that patients with extensive fibrosis on MRI have a significantly increased risk of post-LVAD arrhythmia 3 . Although this study indicates that preoperative left ventricular end‐diastolic diameter (LVEDD) and right ventricular end‐diastolic diameter (RVEDD) predict post-LVAD VAs, it is still unknown how precisely chamber dilatation and arrhythmogenesis are related. Prior studies have employed noninvasive electrocardiographic mapping to map ventricular tachycardia (VT) in LVAD patients and discovered arrhythmic foci, allowing for more targeted therapies 4 . Lastly, the effect of antiarrhythmic drugs or beta-blocker therapy on post-LVAD VA incidence has not been thoroughly investigated in this study, which may influence the risk of arrhythmia and its prognosis. Antiarrhythmic drugs such as amiodarone and beta-blockers are guideline-recommended and most widely used drugs for treating VAs and improving outcomes 5 . Therefore, future research is warranted to involve electrophysiological mapping, and advanced imaging techniques, and explore new pharmacologic options to suppress the risk of VA in LVAD patients. Sincerely, Muhammad Nouman Javed Punjab Medical College, Faisalabad, Pakistan. References 1. Efimova E, Zeynalova S, Eifert S, et al. Echocardiographic Predictors of Ventricular Arrhythmias in Patients with Left Ventricular Assist Devices and Implantable Cardioverter-Defibrillator. J Cardiovasc Electrophysiol. 2025;36(2):387-395. doi:10.1111/jce.16539 2. Yoruk A, Aktas MK, Huang DT, et al. Assessment of Arrhythmia Burden through the Use of an Implantable Cardiac Monitor in Patients with a Continuous Flow Left Ventricular Assist Device. The Journal of Heart and Lung Transplantation. 2020;39(4):S190. doi:10.1016/J.HEALUN.2020.01.782 3. Galand V, Flécher E, Auffret V, et al. Predictors and Clinical Impact of Late Ventricular Arrhythmias in Patients with Continuous-Flow Left Ventricular Assist Devices. JACC Clin Electrophysiol. 2018;4(9):1166-1175. doi:10.1016/j.jacep.2018.05.006 4. Rehorn MR, Koontz J, Barnett AS, et al. Noninvasive electrocardiographic mapping of ventricular tachycardia in a patient with a left ventricular assistance device. HeartRhythm Case Rep. 2020;6(7):398-401. Published 2020 Apr 8. doi:10.1016/j.hrcr.2020.03.015 5. Larson J, Rich L, Deshmukh A, Judge EC, Liang JJ. Pharmacologic Management for Ventricular Arrhythmias: Overview of Anti-Arrhythmic Drugs. Journal of Clinical Medicine. 2022; 11(11):3233. https://doi.org/10.3390/jcm11113233 Information & Authors Information Version history V1 Version 1 04 March 2025 Peer review timeline Published Journal of Cardiovascular Electrophysiology Version of Record 17 Mar 2025 Published Copyright This work is licensed under a Non Exclusive No Reuse License. Collection Journal of Cardiovascular Electrophysiology Keywords basic: cardiac fibrillation/defibrillation clinical: cardiac mapping – electrogram analysis Authors Affiliations Muhammad Javed 0009-0001-6516-4052 Punjab Medical College View all articles by this author Muneeb Khawar 0009-0005-7051-7413 King Edward Medical University View all articles by this author Metrics & Citations Metrics Article Usage 287 views 211 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Muhammad Javed, Muneeb Khawar. Concerns Regarding “Echocardiographic Predictors of Ventricular Arrhythmias in Patients with Left Ventricular Assist Devices and Implantable Cardioverter‐Defibrillator”. Authorea . 04 March 2025. DOI: https://doi.org/10.22541/au.174109881.10671099/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. 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