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Table 5. Comparison of literature models-risk factors affecting bleeding events
Cho et al. Tahsili-Fahadan Gonuguntula et al. Joy et al. Nassif et al. Teuteberg et al.
2020 [19] et al. 2018 [23] 2020 [32] 2016 [34] 2016 [44] 2015 [40]
Age X X
Gender
Hx of AF ** ** * ** ** *
POAF
Intermacs
Hx of cerebrovascular disease or X
transient ischemic attacks
International normalized ratio X X X
Aspirin X X
Mean arterial pressure X
Diabetes mellitus X
Body mass index X
Acute kidney injury X
Peripheral vascular disease X
Hemiplegia/paraplegia X
Moderate/severe liver disease X
Peptic ulcer disease X X
Aortic valve procedure X
Venous thromboembolism X
Mechanical ventilation X
Coronary artery disease X
LVAD implant year X

*AF evaluated, not significant univariate predictor; **AF evaluated in MV or Cox proportional hazards model, not a significant predictor; AF: atrial
fibrillation; POAF: postoperative atrial fibrillation; LVAD: left ventricular assist device.

all significantly associated with POAF in LVAD implant patients . Also, for long-term outcomes, TE
[39]
events (device thrombosis and ischemic stroke) were significantly increased with POAF (OR 5.5,
[30]
CI: 1.4-21.7) . Across publications, however, there was not a consistent association between POAF and
long-term mortality.

Paroxysmal AF
A study by Enriquez et al. categorized persistent AF and paroxysmal AF separately in 106 LVAD patients,
55 of which had AF; this included 36 patients with paroxysmal AF vs. 19 with persistent AF . Of note, the
[14]
AF population for this study included both preoperative AF patients and those who developed AF post-
LVAD following the perioperative period (> 30 days), (50 with AF pre-op and 5 post LVAD implantation).
Comparing AF patients vs. non-AF patients, the heart failure hospitalization rates increased post LVAD
implantation (P < 0.01); however, these AF patients were also older. Moreover, there was a significant trend
for an increased rate of death (P = 0.06) in patients with persistent AF; but there was no difference in heart
failure hospitalization rates for paroxysmal AF patients.

In a large 330 LVAD patient cohort study, patients were followed for 330 days to evaluate their clinical
outcomes. Within the first 30 days post-LVAD, POAF was found in 14% of patients, including 7.8% of
patients without pre-LVAD AF. New-onset AF was associated with increasing age, renal insufficiency, and
lung disease. Of the patients with pre-LVAD paroxysmal AF, 43% had no post-LVAD AF .
[28]