Ventricular Fibrillation in an Ambulatory Patient Supported by a Left Ventricular Assist Device

Abstract

Left ventricular assist devices (LVADs) provide an effective means of managing advanced pump failure as a means of bridging to cardiac transplantation or as permanent therapy. Although ventricular arrhythmias remain common post-LVAD implantation, such therapy may allow malignant arrhythmias to be tolerated hemodynamically. This report describes the clinical findings in a patient who had likely been in a ventricular tachyarrhythmia for several days and presented in ventricular fibrillation, ambulatory, and mentating normally. This report, with previous similar reports, is additive to the body of evidence that LVADs alter the physiologic impact of ventricular arrhythmias in advanced heart failure and highlights the need for thoughtful programming of implantable cardioverter defibrillator therapies in these patients.

Role of Implantable Cardioverter-Defibrillators in Patients With Continuous Flow Ventricular Assist Devices

“…14,15 This allows for the creation of a Fontan-like circulation where even severely depressed or absent right ventricular function, which may occur in the setting of rapid ventricular tachycardia or ventricular fibrillation, can be tolerated without the development of cardiovascular collapse. 13 In this context, the second important finding reported in this article, that an active ICD does not confer an additional survival advantage after implantation of an LVAD, makes intuitive sense. No patient died an arrhythmic death, and the one patient described who could not be resuscitated from refractory ventricular fibrillation was also in septic shock and multiorgan failure.…”

“…These findings are important and additive to previous studies which have demonstrated the absence of a significant decrease in VA burden after LVAD implantation, 8,9 but also enhanced tolerance of VA compared with patients unsupported with a mechanical support device. [10][11][12][13] The reason for tolerance of ventricular fibrillation with LVAD support in these cases likely relates to the marked reduction in pulmonary vascular resistance, which is evident in patient with chronic LVAD support. 14,15 This allows for the creation of a Fontan-like circulation where even severely depressed or absent right ventricular function, which may occur in the setting of rapid ventricular tachycardia or ventricular fibrillation, can be tolerated without the development of cardiovascular collapse.…”

İleri evre kalp yetersizliği rehberi

“…Ancak ventriküler fibrilasyon ve asistol gibi hayatı tehdit edici bir aritmide dahi cihazın debisi nedeniyle hasta asemptomatik kalabilir. [331] Ventrikü-ler aritmiler cihaz olgularında ani ölüm nedeni değil-dirler ve ICD'nin sağ kalıma olumlu bir etkisi yoktur. [330] Ancak ciddi ventriküler ve atriyal aritmiler sağ kalp fonksiyonlarına olumsuz etkileri nedeniyle tedavi edilmelidirler.…”

Clinical Experience of Combined HeartWare Ventricular Assist Device and Implantable Cardioverter Defibrillator Therapy

“…Compared to previous used pulsatile VADs, the continuous flow LVADs are less dependent on contractility from native heart. Few cases have been published where sustaining VAs under continuous flow LVAD support have been hemodynamically well tolerated . However, appropriate detection and termination of sustaining VAs may be essential to ensure adequate right ventricular function and prevent from cardiogenic shock.…”