Background: Atrial fibrillation (AF) is a well-established risk factor of thromboembolism (TE). Thromboembolism is one of the most common complications in patients supported by continuous-flow left ventricular assisted device (CF-LVAD). However, the association between AF and TE complications in this population is controversial. We conducted a systematic review and meta-analysis to assess the association between AF and overall TE, stroke and device thrombosis events in CF-LVAD patients.
Methods: We performed a comprehensive literature search through April 30, 2017 in the databases of MEDLINE and EMBASE. Included studies were published prospective or retrospective cohort studies that compared the risk of developing overall TE, stroke, and device thrombosis events in CF-LVAD patients with AF and those without AF. We calculated pooled relative risk (RR) with 95% confidence intervals (CIs) and I2 statistic using the random-effects model.
Results: Ten studies were included in this meta-analysis. Overall TE outcome was available in 4 studies involving 1,106 AF and 3,556 non-AF patients. Stroke outcome was available in 7 studies involving 1,455 AF and 4,037 non-AF patients. Device thrombosis outcome was available in 3 studies involving 1,010 AF and 3327 non-AF patients. There was no association between AF and TE (RR, 0.95; 95% CI, 0.57-1.59, I2=79%), stroke (RR, 1.10; 95% CI, 0.74-1.64, I2=73%), and device thrombosis events (RR, 0.97; 95% CI, 0.56-1.67, I2=42%) (Figure 1).
Conclusions: Atrial fibrillation in CF-LVAD patients was not associated with overall TE, stroke, and device thrombosis events. These findings might be explained by highly thrombogenic property of CF-LVADs that exceeds the thromboembolic risk driven by AF.