Background Ventricular arrhythmias in left-ventricular assist-device (LVAD) recipients represent a challenging clinical scenario and the optimal treatment strategy in this unique patient population still needs to be defined. Case summary We report on a 61-year-old LVAD patient with incessant ventricular fibrillation (VF) despite multiple unsuccessful attempts to restore normal rhythm with external defibrillation and antiarrhythmic medication. He remained initially stable as an outpatient but gradually developed secondary organ failure. Discussion This case demonstrates that under LVAD support long-term hemodynamic stability is possible even in case of VF, a situation that resembles Fontan circulation. However, ventricular arrhythmias are associated with high risk of secondary organ damage due to right heart failure if left untreated. In case of refractory ventricular tachycardia or electrical storm listing for heart transplantation with high priority status should be pursued when possible. Alternatively, catheter ablation may be considered in selected cases and be performed in experienced centers in close collaboration with all involved specialists. Primary Specialties involved other than cardiology cardiothoracic surgery, palliative care medicine

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Aims: To investigate if community detected Metabolic Syndrome (MetS) is associated with the burden of incipient HFpEF in the community. Methods and Results: We prospectively studied 148 consecutive MetS patients identified from the Lithuanian High Cardiovascular Risk primary prevention programme and investigated them further for unknown HFpEF through cardiopulmonary stress testing as well as assessment of BNP levels and of arterial stiffness. Subjects with a peak VO2 value lower than 90% of predicted and/or BNP≥35 ng/l were categorized as having early phase HFpEF. For comparison of this early phase HFpEF with others already clinically diagnosed with HFpEF, patients with both established HFpEF and MetS were selected retrospectively from patients attending our cardiopulmonary stress testing laboratory (n=38). Two thirds of the screening programme-derived MetS population (n=96) demonstrated a reduced exercise capacity and/or an elevated BNP, indicating signs of early HFpEF. Both the clinically diagnosed HFpEF and the screening programme detected MetS group with early HFpEF demonstrated similarly decreased exercise tolerance evaluated by peak oxygen uptake (79.8 ± 22.1% vs 82.7 ± 14.0%, p>0.05). Analysis of arterial markers in the screening programme group revealed statistically significant differences of augmentation index values between groups with and without signs of early HFpEF (p=0.016).Conclusion: A considerable proportion of patients having MetS may be diagnosed with previously undetected early stage HFpEF. The use of objective parameters of exercise capacity and neurohormonal activation might be effectively used for the early detection of HFpEF. Also early HFpEF in this setting is found to be associated with increased arterial stiffness.

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