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Reduced LV Pacing Percentages are Associated with Progressively Worse Measures of Heart Failure Physiology in CRT Patients
The 22nd Annual Scientific Meeting HFSA management. Methods: Consecutive patients undergoing ICD interrogation were assessed for history of AF and HFrEF and AF management strategy. Strategies were categorized as rate control, anti-arrhythmic medication rhythm control, or curative ablation (RFA). Use of anticoagulation was also assessed along with patient co-morbidities. Results: Sixty-seven patients (76% men, mean age 70) with LVEF 35% and AF were assessed over a six month period in ICD clinic. A strategy of rate control was pursued in 34.3%, rhythm control in 35.8%, and RFA in 28.4% (remainder were untreated). Anticoagulation was employed in 82.1%. The most commonly used antiarrhythmic medication was amiodarone and most common anticoagulant was warfarin. Conclusions: These findings portray a conservative approach to AF in the HFrEF population, with fewer than 30% of patients undergoing RFA. These data suggest that further large trials with positive outcomes for RFA in HFrEF population will likely be required to overcome conflicting data and current treatment patterns of AF in this population, given the patients’ co-morbidities.
169 Trends in Comorbidities and 1-Year Mortality after Implantable Cardioverter Defibrillator Implantation Within The Veteran Affairs Health System Marat Fudim1, Tarek Ajam2, Srikant Devaraj3, Andrew Ambrosy1, Sean Pokorney1, Masoor Kamalesh4; 1Duke University, Durham, NC; 2Saint Loius University, Saint Loius, MO; 3Ball State University, Muncie, IN; 4Indiana University, Indianapolis, IN Background: Implantable cardioverter-defibrillator (ICD) therapy improves mortality in patients with heart failure (HF) but current guidelines advise against implantation of ICDs in patients with a life expectancy of less than 1 year. We examined the 1-year mortality rate and burden of comorbid diseases in patients who underwent primary or secondary prevention ICD in the Veterans Affairs (VA) Health System. Methods: The analysis included US veterans with a diagnosis of heart failure and reduced ejection fraction (HFrEF) and a new implantation of primary or secondary prevention ICD. Patients treated nationwide in the VA-Health System from January 2007 to January 2015 were included. Diagnosis of HFrEF and ICD implantation was established through ICD9-codes. Mortality data were obtained fromthe VA’s death registry. We described the Charlson Comorbidity Index (high value = high comorbid index) and all-cause mortality rates within 1 year of device implantation. Results: We identified 17,901 VA patients with HFrEF and new ICD implantation. Patients were on average 66 § 10 years old, predominantly male (99%), and had a history of coronary artery disease (81%), chronic kidney disease (42%) and diabetes mellitus (56%). Average Charlson Comorbidity Index was 3.0 (SD §1.5). The Comorbidity Index gradually decreased from 2007 to 2014 from 3.1 to 2.8 which represented a statistically significant decrease after the year 2011 (p<0.001 for 2011-2014) (Figure). Among the national patient sample, 2,329 patients died within 1 year of ICD implant (13%, SD § 0.9%). There was no statistically significant difference in 1-year mortality from 2007 to 2014 (P>0.05) (Figure). Discussion: Amongst patients with HFrEF and a new ICD implantation, we found a high 1-year mortality rate. The 1-year mortality rate remained unchanged over an 8-year period even despite a slowly decreasing burden of comorbid disease among ICD patients over the same time period. Future work needs to identify patients with a reduced chance of survival and apply specific risk prediction scores for the selection of appropriate ICD candidates in the VA population.
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Introduction: The third heart sound (S3), caused by rapid deceleration of the blood against a stiff ventricle during early diastolic filling, is an early and specific sign of heart failure and elevated filling pressure. Studies have shown S3 to be coincident with deceleration phase of E-wave and associated with a steeper E-wave. Atrial fibrillation (AF) is a common comorbidity in HF, however questions have arisen regarding the ability to reliably detect S3 during AF as typically it is difficult to auscultate an S3 during AF. Here we present a case of simultaneous implanted device measured heart sound (HS) and echo data while the patient was in AF. Methods: MultiSENSE enrolled patients implanted with COGNIS CRT-D devices and followed for up to a year. At enrollment CRT-Ds were converted to enable collection of HS data using device based accelerometer. HS data was periodically collected as ensemble averaged (EA) waveforms of multiple neighboring beats that closely matched in RR interval. An optional echo was conducted if the patient was hospitalized for worsening HF. An independent core laboratory measured parameters from the echo images, including E-wave timing within the cardiac cycle (Q-E interval and E-wave deceleration time or EDT). EA waveforms over multiple days around the day of echo that matched the average heart rate (HR) around the echo exam to within 10 beats per min were identified and compared against E-wave timing. Results: The patient, enrolled in November 2011 and reported to have a history of AF, was hospitalized for worsening HF on day 38 post enrollment. Device interrogation revealed ongoing AF burden of 24 hours since enrollment which transiently terminated on day 41 for several days before reverting to 24 hour AF burden. Patient underwent an echocardiogram starting at 9:22AM on day 39, which showed a Q-E interval of 562msec and EDT of 169msec. Figure shows one heart sound EA recorded at 10:49AM and clearly shows cardiac vibrations during the deceleration phase of the E-wave as deduced from Q-E interval and EDT (horizontal line). This observation is consistent across all EAs collected over 5 days around the day of the echo with matched HR. Conclusion: Consistent with its known physiologic genesis, S3 measured using an implanted device occurred during the deceleration phase of early diastolic filling even when the patient was in AF. A device based objective measure may provide more consistent assessment of S3 than auscultation in the midst of an arrhythmic rumble of AF.
171 Reduced LV Pacing Percentages are Associated with Progressively Worse Measures of Heart Failure Physiology in CRT Patients Michael Cao1, Edward J. Schloss2, John H. Lobban3, Rezwan Ahmed4, Craig M. Stolen4, John P. Boehmer5; 1Golden Heart Medical, Rosemead, CA; 2The Christ Hospital Physicians, Cincinnati, OH; 3Monongalia General Hospital, Morgantown, WV; 4 Boston Scientific, Saint Paul, MN; 5Penn State Hershey Medical Center, Hershey, PA
170 Third Heart Sound During Atrial Fibrillation? Confirming the Existence of Cardiac Vibrations During Deceleration Phase of Early Diastolic Filling While in Atrial Fibrillation George Mark1, Pramod Thakur2, Qi An2, Viktoria Averina2, John Boehmer3; 1Cooper University Hospital, Camden, NJ; 2Boston Scientific, St. Paul, MN; 3Penn State Hershey Medical Center, Hershey, PA
Introduction: HeartLogic, an implanted device based heart failure (HF) index and alert algorithm, aggregates physiologic trends associated with multiple aspects of heart failure status (e.g. heart sounds, heart rate, thoracic impedance, respiration rate, tidal volume, and activity). HeartLogic alerts were recently shown to detect HF events with 70% sensitivity and 34 days of advanced warning, and identify patients with 10-fold increased risk of worsening HF. Separately, lower LV pacing percentages have been associated with significantly worse survival in a cohort of >35000 remotely monitored CRT patients. This current analysis investigated whether a deteriorating HF status would be suggested by continuous measures of heart failure pathophysiology at lower pacing percentages. Methods: Sensor data was obtained from 900 ambulatory HF patients with implanted CRT devices for up to a year in the MultiSENSE study. The percent of heart beats with LV pacing was assessed for periods (median = 7.3 days; IQR: 6.4 - 43.4) between data downloads (median = 55 periods/ patient; IQR: 10 - 68) and compared to the sensor data. Results: Worsening sensor trends were found with progressively lower pacing percentages (See Figure). While
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IN the HeartLogic alert state (above an Index of 16) the odds of optimal LV pacing (>98%) were less than when OUT of the HeartLogic alert state for a given subject (OR: 0.655; 95% CI: 0.626 - 0.686; p<0.0001). Conclusion: Lower LV pacing percent is associated with multiple markers of worsening HF, and patients in HeartLogic alert are more likely to have sub-optimal LV pacing. The impact of HeartLogic alert driven interventions on the percent biventricular pacing and outcomes is being assessed in the MANAGE-HF clinical trial.
the largest series of leadless LV endocardial CRT yet reported. Patients were predominantly male with a mean age of 68.3§ 10.4 years, a mean LVEF of 31% § 9.1 and a mean QRS duration of 195.8 § 120.0ms. Ischemic etiology was present in 37.5% of patients. Successful implantation and chronic delivery of BiV ENDO pacing via the WiSE-CRT system was achieved in 97% of patients. Acute (<24hrs) and 30 day complications rates were 5.9% and 23.5% respectively. Conclusion: This is the largest international series of the WiSE-CRT pacing system to date. In a real-world setting, leadless LV endocardial CRT proved technically feasible with a high success rate and similar complication rate to that previously described. BiV ENDO is a safe and effective therapeutic option for patients who fail to improve following transvenous, epicardial CRT. Table 1. Complications
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172 Real World Experience of Leadless LV Endocardial CRT with the WiSE CRT Pacing System; An International Study Benjamin J. Sieniewicz1, Timothy R. Betts2, Simon James3, Andrew J. Turley3, Christian Butter4, Martin Seifert4, Lucas V. A. Boersma5, Sam Riahi6, Petr Neuzil7, Mauro Biffi8, Igor Diemberger8, Martin Arnold9, David T. Keane10, Pascal Defaye11, Jean-Claude Deharo12, Christopher A. Rinaldi1; 1King’s College London, London, United Kingdom; 2Oxford University Hospitals, Oxford, United Kingdom; 3James Cook University Hospital, Middlesbrough, United Kingdom; 4Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany; 5St Antonius Ziekenhuis, Nieuwegein, Utrecht, Netherlands; 6Aalborg University Hospital, Aalborg, Denmark; 7Na Homolce Hospital, Prague, Czech Republic; 8Policlinico S’Orsola, Bologna, Italy; 9 University Hospital Erlangen, Erlangen, Germany; 10St. Vincent’s University Hospital, Dublin, Ireland; 11CHU Grenoble Alpes, Grenoble, France; 12Hopital La Timone, Marseille, France Introduction: Biventricular endocardial pacing (BiV ENDO) is a potential therapy for heart failure patients who either cannot receive transvenous, epicardial CRT (BiV EPI) or who have failed to respond. BiV ENDO is traditionally delivered via trans-septal pacing leads, mandating lifelong anti-coagulation due to thromboembolic complications. The introduction of a new wireless LV endocardial pacing system (WiSE-CRT System, EBR Systems, Sunnyvale, California) avoids the need for long-term anticoagulation. Objective: We sought to assess the safety & efficacy of the WiSE-CRT system during real world clinical use in an international registry. Methods: Registry of centres implanting the WiSE-CRT system as part of the WICS Post Market Surveillance Registry (Clinical trial study number NCT02610673) Results: A total of 68 patients across the 12 centers underwent implantation with the WiSE-CRT system,
Predictors of Early (<30 Days) and Late (>30 Days) Onset De Novo Ventricular Arrhythmia Following Continuous Flow- Left Ventricular Assist Device (CFLVAD) Implantation Faisal H. Cheema, Deep Pujara, Brian D. Greet, Ajith Nair, L. Simpson, Andrew Civitello, Francia Rojas-Delgado, Jei Cheng, Jeffrey Morgan, Nilesh Mathuria; Baylor College of Medicine & Texas Heart Institute, Houston, TX Background: A significant proportion of patients develop new onset ventricular arrhythmia (VAs) after implantation of continuous-flow left ventricular assist devices (CF-LVADs). Factors associated with these de novo VAs remain unexplored. Objective: Identify factors associated with de-novo ventricular arrhythmia after CF-LVAD implantation. Methods: A single center retrospective review of patients undergoing CF-LVAD implantation between 2000 and 2015 was done to identify patients without any history of VAs. Patient characteristics, operative variables and outcomes including development of arrhythmias were assessed. Results: 296 patients without previously documented ventricular arrhythmia underwent CF-LVAD implant. Two hundred and thirty (77.7%) remained free of VAs for their respective duration of follow-up. The remaining 66 (22.3%) patients developed de novo ventricular arrhythmia (VAs). Of these, 37 (12.5%) had early onset (<30 days) while 29 (9.8%) had late onset (>30 days) de-novo VAs. On multivariable analysis, need for temporary mechanical circulatory support (OR:2.15, p=0.013); diabetes mellitus (OR: 1.79, p=0.043); pre-op hemoglobin <10 gm/dL (OR:3.30, p=0.004) and LDH >600 U/L (OR:0.53, p=0.041) were associated with early onset de-novo VAs. Low ejection fraction <20% (OR:2.98, p=0.039) was associated with late onset de novo VAs. Left Ventricular internal diameter in diastole (LVIDd) [Ref. Category - <6 cm; 6-7.5 cm (OR:3.18, p=0.087) and >7.5 cm (OR: 3.90, P=0.099)] and history of diabetes mellitus (OR:2.07, p=0.083) also exhibited statistical trends towards late onset de novo VAs in the multivariable model. Conclusions: Whereas immediate preoperative clinical status or comorbidities of the patients undergoing CF-LVAD implant predicted early onset VAs, the structural and compromised functional cardiac status turned out to be predictors for late onset de novo VAs.
169 Trends in Comorbidities and 1-Year Mortality after Implantable Cardioverter Defibrillator Implantation Within The Veteran Affairs Health System Marat Fudim1, Tarek Ajam2, Srikant Devaraj3, Andrew Ambrosy1, Sean Pokorney1, Masoor Kamalesh4; 1Duke University, Durham, NC; 2Saint Loius University, Saint Loius, MO; 3Ball State University, Muncie, IN; 4Indiana University, Indianapolis, IN Background: Implantable cardioverter-defibrillator (ICD) therapy improves mortality in patients with heart failure (HF) but current guidelines advise against implantation of ICDs in patients with a life expectancy of less than 1 year. We examined the 1-year mortality rate and burden of comorbid diseases in patients who underwent primary or secondary prevention ICD in the Veterans Affairs (VA) Health System. Methods: The analysis included US veterans with a diagnosis of heart failure and reduced ejection fraction (HFrEF) and a new implantation of primary or secondary prevention ICD. Patients treated nationwide in the VA-Health System from January 2007 to January 2015 were included. Diagnosis of HFrEF and ICD implantation was established through ICD9-codes. Mortality data were obtained fromthe VA’s death registry. We described the Charlson Comorbidity Index (high value = high comorbid index) and all-cause mortality rates within 1 year of device implantation. Results: We identified 17,901 VA patients with HFrEF and new ICD implantation. Patients were on average 66 § 10 years old, predominantly male (99%), and had a history of coronary artery disease (81%), chronic kidney disease (42%) and diabetes mellitus (56%). Average Charlson Comorbidity Index was 3.0 (SD §1.5). The Comorbidity Index gradually decreased from 2007 to 2014 from 3.1 to 2.8 which represented a statistically significant decrease after the year 2011 (p<0.001 for 2011-2014) (Figure). Among the national patient sample, 2,329 patients died within 1 year of ICD implant (13%, SD § 0.9%). There was no statistically significant difference in 1-year mortality from 2007 to 2014 (P>0.05) (Figure). Discussion: Amongst patients with HFrEF and a new ICD implantation, we found a high 1-year mortality rate. The 1-year mortality rate remained unchanged over an 8-year period even despite a slowly decreasing burden of comorbid disease among ICD patients over the same time period. Future work needs to identify patients with a reduced chance of survival and apply specific risk prediction scores for the selection of appropriate ICD candidates in the VA population.
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Introduction: The third heart sound (S3), caused by rapid deceleration of the blood against a stiff ventricle during early diastolic filling, is an early and specific sign of heart failure and elevated filling pressure. Studies have shown S3 to be coincident with deceleration phase of E-wave and associated with a steeper E-wave. Atrial fibrillation (AF) is a common comorbidity in HF, however questions have arisen regarding the ability to reliably detect S3 during AF as typically it is difficult to auscultate an S3 during AF. Here we present a case of simultaneous implanted device measured heart sound (HS) and echo data while the patient was in AF. Methods: MultiSENSE enrolled patients implanted with COGNIS CRT-D devices and followed for up to a year. At enrollment CRT-Ds were converted to enable collection of HS data using device based accelerometer. HS data was periodically collected as ensemble averaged (EA) waveforms of multiple neighboring beats that closely matched in RR interval. An optional echo was conducted if the patient was hospitalized for worsening HF. An independent core laboratory measured parameters from the echo images, including E-wave timing within the cardiac cycle (Q-E interval and E-wave deceleration time or EDT). EA waveforms over multiple days around the day of echo that matched the average heart rate (HR) around the echo exam to within 10 beats per min were identified and compared against E-wave timing. Results: The patient, enrolled in November 2011 and reported to have a history of AF, was hospitalized for worsening HF on day 38 post enrollment. Device interrogation revealed ongoing AF burden of 24 hours since enrollment which transiently terminated on day 41 for several days before reverting to 24 hour AF burden. Patient underwent an echocardiogram starting at 9:22AM on day 39, which showed a Q-E interval of 562msec and EDT of 169msec. Figure shows one heart sound EA recorded at 10:49AM and clearly shows cardiac vibrations during the deceleration phase of the E-wave as deduced from Q-E interval and EDT (horizontal line). This observation is consistent across all EAs collected over 5 days around the day of the echo with matched HR. Conclusion: Consistent with its known physiologic genesis, S3 measured using an implanted device occurred during the deceleration phase of early diastolic filling even when the patient was in AF. A device based objective measure may provide more consistent assessment of S3 than auscultation in the midst of an arrhythmic rumble of AF.
171 Reduced LV Pacing Percentages are Associated with Progressively Worse Measures of Heart Failure Physiology in CRT Patients Michael Cao1, Edward J. Schloss2, John H. Lobban3, Rezwan Ahmed4, Craig M. Stolen4, John P. Boehmer5; 1Golden Heart Medical, Rosemead, CA; 2The Christ Hospital Physicians, Cincinnati, OH; 3Monongalia General Hospital, Morgantown, WV; 4 Boston Scientific, Saint Paul, MN; 5Penn State Hershey Medical Center, Hershey, PA
170 Third Heart Sound During Atrial Fibrillation? Confirming the Existence of Cardiac Vibrations During Deceleration Phase of Early Diastolic Filling While in Atrial Fibrillation George Mark1, Pramod Thakur2, Qi An2, Viktoria Averina2, John Boehmer3; 1Cooper University Hospital, Camden, NJ; 2Boston Scientific, St. Paul, MN; 3Penn State Hershey Medical Center, Hershey, PA
Introduction: HeartLogic, an implanted device based heart failure (HF) index and alert algorithm, aggregates physiologic trends associated with multiple aspects of heart failure status (e.g. heart sounds, heart rate, thoracic impedance, respiration rate, tidal volume, and activity). HeartLogic alerts were recently shown to detect HF events with 70% sensitivity and 34 days of advanced warning, and identify patients with 10-fold increased risk of worsening HF. Separately, lower LV pacing percentages have been associated with significantly worse survival in a cohort of >35000 remotely monitored CRT patients. This current analysis investigated whether a deteriorating HF status would be suggested by continuous measures of heart failure pathophysiology at lower pacing percentages. Methods: Sensor data was obtained from 900 ambulatory HF patients with implanted CRT devices for up to a year in the MultiSENSE study. The percent of heart beats with LV pacing was assessed for periods (median = 7.3 days; IQR: 6.4 - 43.4) between data downloads (median = 55 periods/ patient; IQR: 10 - 68) and compared to the sensor data. Results: Worsening sensor trends were found with progressively lower pacing percentages (See Figure). While
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Journal of Cardiac Failure Vol. 24 No. 8S August 2018
IN the HeartLogic alert state (above an Index of 16) the odds of optimal LV pacing (>98%) were less than when OUT of the HeartLogic alert state for a given subject (OR: 0.655; 95% CI: 0.626 - 0.686; p<0.0001). Conclusion: Lower LV pacing percent is associated with multiple markers of worsening HF, and patients in HeartLogic alert are more likely to have sub-optimal LV pacing. The impact of HeartLogic alert driven interventions on the percent biventricular pacing and outcomes is being assessed in the MANAGE-HF clinical trial.
the largest series of leadless LV endocardial CRT yet reported. Patients were predominantly male with a mean age of 68.3§ 10.4 years, a mean LVEF of 31% § 9.1 and a mean QRS duration of 195.8 § 120.0ms. Ischemic etiology was present in 37.5% of patients. Successful implantation and chronic delivery of BiV ENDO pacing via the WiSE-CRT system was achieved in 97% of patients. Acute (<24hrs) and 30 day complications rates were 5.9% and 23.5% respectively. Conclusion: This is the largest international series of the WiSE-CRT pacing system to date. In a real-world setting, leadless LV endocardial CRT proved technically feasible with a high success rate and similar complication rate to that previously described. BiV ENDO is a safe and effective therapeutic option for patients who fail to improve following transvenous, epicardial CRT. Table 1. Complications
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172 Real World Experience of Leadless LV Endocardial CRT with the WiSE CRT Pacing System; An International Study Benjamin J. Sieniewicz1, Timothy R. Betts2, Simon James3, Andrew J. Turley3, Christian Butter4, Martin Seifert4, Lucas V. A. Boersma5, Sam Riahi6, Petr Neuzil7, Mauro Biffi8, Igor Diemberger8, Martin Arnold9, David T. Keane10, Pascal Defaye11, Jean-Claude Deharo12, Christopher A. Rinaldi1; 1King’s College London, London, United Kingdom; 2Oxford University Hospitals, Oxford, United Kingdom; 3James Cook University Hospital, Middlesbrough, United Kingdom; 4Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany; 5St Antonius Ziekenhuis, Nieuwegein, Utrecht, Netherlands; 6Aalborg University Hospital, Aalborg, Denmark; 7Na Homolce Hospital, Prague, Czech Republic; 8Policlinico S’Orsola, Bologna, Italy; 9 University Hospital Erlangen, Erlangen, Germany; 10St. Vincent’s University Hospital, Dublin, Ireland; 11CHU Grenoble Alpes, Grenoble, France; 12Hopital La Timone, Marseille, France Introduction: Biventricular endocardial pacing (BiV ENDO) is a potential therapy for heart failure patients who either cannot receive transvenous, epicardial CRT (BiV EPI) or who have failed to respond. BiV ENDO is traditionally delivered via trans-septal pacing leads, mandating lifelong anti-coagulation due to thromboembolic complications. The introduction of a new wireless LV endocardial pacing system (WiSE-CRT System, EBR Systems, Sunnyvale, California) avoids the need for long-term anticoagulation. Objective: We sought to assess the safety & efficacy of the WiSE-CRT system during real world clinical use in an international registry. Methods: Registry of centres implanting the WiSE-CRT system as part of the WICS Post Market Surveillance Registry (Clinical trial study number NCT02610673) Results: A total of 68 patients across the 12 centers underwent implantation with the WiSE-CRT system,
Predictors of Early (<30 Days) and Late (>30 Days) Onset De Novo Ventricular Arrhythmia Following Continuous Flow- Left Ventricular Assist Device (CFLVAD) Implantation Faisal H. Cheema, Deep Pujara, Brian D. Greet, Ajith Nair, L. Simpson, Andrew Civitello, Francia Rojas-Delgado, Jei Cheng, Jeffrey Morgan, Nilesh Mathuria; Baylor College of Medicine & Texas Heart Institute, Houston, TX Background: A significant proportion of patients develop new onset ventricular arrhythmia (VAs) after implantation of continuous-flow left ventricular assist devices (CF-LVADs). Factors associated with these de novo VAs remain unexplored. Objective: Identify factors associated with de-novo ventricular arrhythmia after CF-LVAD implantation. Methods: A single center retrospective review of patients undergoing CF-LVAD implantation between 2000 and 2015 was done to identify patients without any history of VAs. Patient characteristics, operative variables and outcomes including development of arrhythmias were assessed. Results: 296 patients without previously documented ventricular arrhythmia underwent CF-LVAD implant. Two hundred and thirty (77.7%) remained free of VAs for their respective duration of follow-up. The remaining 66 (22.3%) patients developed de novo ventricular arrhythmia (VAs). Of these, 37 (12.5%) had early onset (<30 days) while 29 (9.8%) had late onset (>30 days) de-novo VAs. On multivariable analysis, need for temporary mechanical circulatory support (OR:2.15, p=0.013); diabetes mellitus (OR: 1.79, p=0.043); pre-op hemoglobin <10 gm/dL (OR:3.30, p=0.004) and LDH >600 U/L (OR:0.53, p=0.041) were associated with early onset de-novo VAs. Low ejection fraction <20% (OR:2.98, p=0.039) was associated with late onset de novo VAs. Left Ventricular internal diameter in diastole (LVIDd) [Ref. Category - <6 cm; 6-7.5 cm (OR:3.18, p=0.087) and >7.5 cm (OR: 3.90, P=0.099)] and history of diabetes mellitus (OR:2.07, p=0.083) also exhibited statistical trends towards late onset de novo VAs in the multivariable model. Conclusions: Whereas immediate preoperative clinical status or comorbidities of the patients undergoing CF-LVAD implant predicted early onset VAs, the structural and compromised functional cardiac status turned out to be predictors for late onset de novo VAs.