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Obeid et al. Vessel Plus 2022;6:43 https://dx.doi.org/10.20517/2574-1209.2021.136 Page 9 of 14

Table 6. Comparison of literature models-risk factors affecting stroke (ischemic, hemorrhagic, or either)
Colombo et al. Cho et al. Tahsili-Fahadan Parikh et al. Morris et Izzy et al. Iwasaki et al.
2020 [18] 2020 [19] et al. 2018 [23] 2020 [24] al. 2015 [47] 2018 [45] 2020 [29]
Age
Gender X X X
Hx of AF * ** ** ** * * *
POAF
Intermacs
Device type X
Peripheral vascular disease X
International normalized ratio X
Left ventricular thrombus X
Coronary artery disease X
Hx of cerebrovascular disease X
or transient ischemic attach
Right ventricular failure X
Albumin X X
Pulmonary disease X
Low cardiac index X
Body mass index X
Time in the therapeutic range 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.

Associations with ventricular arrhythmias
One prospective observational study examined ventricular tachycardia events in pre- and post-LVAD
patients (n = 98), of which 75% had AF pre-LVAD implantation. Preoperative AF was found to be a
predisposing factor to the development of post-op ventricular arrhythmia events, along with a history of
pre-op ventricular arrhythmia and larger left ventricular end-diastolic diameters. This study did not find
effects on mortality in patients with a history of AF or in patients with post-op ventricular arrhythmias .
[52]
Another retrospective study did find an association between AF and ventricular arrhythmias in which
recurrent ventricular arrhythmias were associated with increased mortality .
[16]

R
Other mechanical life support (ECMO and Impella )
Postoperative AF has been briefly studied in patients with cardiogenic shock in the acute setting requiring
mechanical circulatory support. Two observational cohort studies investigating predisposing factors for
survival and adverse outcomes in patients on ECMO studied AF in this population without finding any
significant effect on either survival or mortality [53,54] . The effect of AF on outcomes in patients with acute
R
[55]
myocardial infarction requiring Impella support was examined in a large database study . It found that
AF was associated with increased respiratory complications and increased healthcare expenses in the form
of longer length of stay, more frequent transfer to facilities upon discharge and higher hospital charges.
However, all-cause in-hospital mortality was similar in the AF and no AF groups. This study did not
differentiate between pre-procedure and post-procedure AF due to the nature of data collection using ICD-
9 codes extracted from an administrative database. Another study investigated the effect of arrhythmias on
109 consecutive survivors of sudden cardiac death requiring Impella support . It did not find associations
R
[56]
with either ventricular or supraventricular arrhythmias, including pre-procedure and post-procedure AF on
R
mortality, suggesting that the Impella device may compensate for the hemodynamic imbalances caused by
arrhythmias in the acute setting. The same may be applicable in the ECMO population. Furthermore, the
acuity of these patients and high early mortality rates obfuscate any long-term adverse effects AF may have.