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Obeid et al. Vessel Plus 2022;6:43 https://dx.doi.org/10.20517/2574-1209.2021.136 Page 11 of 14

Until now, only retrospective observational reports have been occasionally included in meta-analysis (Class
III evidence). As a critical “gap” in knowledge identified by this review, this field lacks the advantage of any
prospective database analyses - where data have been captured for mechanical support patients to address
this question directly. Additionally, it was surprising to learn that there are no randomized trials on this
specific topic, as other atrial fibrillation rate and rhythm control strategies have not been targeted for
evaluation in this higher-risk patient subpopulation, treating AF by trans-catheter ablation or left atrial
appendage clipping at the time of LVAD implantation are known strategies that lack data in this population.
Beyond the LVAD studies identified, moreover, there have been no studies published evaluating
preoperative AF in mechanical circulatory support patients, or the impact of mechanical circulatory post-
procedural AF rates on these patients’ outcomes. Of the patients experiencing post-procedural AF, it is
unknown as to what interventions may be life-prolonging. Additional research now appears warranted to
provide evidence-based, data-driven mechanical circulatory support procedural guidelines for preoperative
AF and postoperative AF treatments for this unique patient population.

To summarize, preoperative AF, as opposed to POAF, seems to have a little discernable effect on outcomes
in HF patients requiring mechanical circulatory support. Despite the major registries for LVAD and ECMO
[i.e., the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) and
Extracorporeal Life Support Organization (ELSO) registries] reporting cardiac arrythmia in their
postoperative data collection form, preoperative AF and POAF have not been specifically evaluated. Given
these database monitoring programs have been initiated to improve mechanical circulatory support
patients’ quality of care, high integrity preoperative AF and postoperative AF data should be gathered and
analyzed in the future.

DECLARATIONS
Authors’ contributions
Concept, drafting, analysis, critical revision, final approval: Obeid JM, Yaligar A, McLarty AJ, Bilfinger TV,
Tannous HJ, Shroyer ALW
Data collection: Obeid JM, Yaligar A

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2022.