Wearable cardioverter defibrillators (WCDs) are external devices capable of continuous cardiac rhythm monitoring as well as automatic detection and defibrillation of potentially life-threatening arrhythmias such as ventricular tachycardia (VT) and ventricular fibrillation (VF). They are an alternative approach for patients when an implantable cardioverter defibrillator (ICD) is not appropriate. Although treatment with ICD is considered highly effective for the primary and secondary prevention of sudden cardiac death (SCD) in high-risk patients susceptible to VT and VF, patients may still experience psychological difficulties such as fear of shock, avoidance of normal behaviors and reduced quality of life. One of these phenomena is phantom shock (PS), which is defined as a perception of having received a shock with no evidence of recorded defibrillation upon device interrogation. While PS has been reported in the ICD literature, to the best of our knowledge, we present the first known case of WCD-related PS. We also present a review of the current literature to explore the prevalence of PS, the factors associated with its pathogenesis and interventional studies aimed at reducing its occurrence. We highlight this case because PS is considered a phenomenon that few recognize, which should be discriminated from real device shocks before clinicians initiate treatment, device reprogramming or device discontinuation. We describe the psychosocial factors associated with PS to emphasize the importance of managing any associated psychiatric disorders and psychosocial factors both before and after initiation of device treatment.
Patients with end stage heart failure often develop pulmonary hypertension which resolves after placement of left ventricular assist device (LVAD). Some patients develop persistent pulmonary hypertension despite LVAD implantation. This excludes them from being able to receive a heart transplant. High pulmonary vascular resistance is associated with poor prognosis in patients with LVAD. There are no treatment guidelines available for long term treatment of pulmonary hypertension in LVAD patients in an ambulatory setting. We present a case of persistently high pulmonary vascular resistance in a patient with LVAD who qualified for heart transplant, after his pulmonary vascular resistance and pulmonary artery pressures were successfully reduced with combination of sildenafil, selexipag and macitentan. As to our knowledge, treatment of persistent pulmonary hypertension post LVAD with long-term selexipag has not been reported in the literature. Patients with persistent pulmonary hypertension despite LVAD implantation should be assessed and treated in the ambulatory setting with pulmonary vasodilator therapy to decrease mortality and aid in candidature for heart transplantation.
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