Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmia in Continuous-Flow Left Ventricular Assist Device

Vlismas, Peter; Rochlani, Yogita; Romero, Jorge; Scheinin, S.; Shin, J.; Goldstein, Daniel J.; Jorde, Ulrich P.

doi:10.1016/j.jaccas.2020.12.041

Cited by 8 publications

(5 citation statements)

References 10 publications

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“…By decreasing sympathetic activity, sympathetic denervation has been shown to diminish the occurrence of persistent VA or the usage of ICD [ 59 ]. Vlismas et al [ 60 ] reported that sympathetic denervation was performed in 1 female patient with intermittent VA after LVAD implantation, and no recurrence was observed at the 8-month postoperative follow-up, implying that sympathetic denervation may be considered for patients with postoperative VA implanted with LVADs who are refractory to medical, ablative, or ICD therapy.…”

Section: Discussionmentioning

confidence: 99%

A Review of New-Onset Ventricular Arrhythmia after Left Ventricular Assist Device Implantation

Shi

Liu³

2022

Cardiology

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Introduction: Heart failure (HF) is a severe and terminal stage of various heart diseases. Left ventricular assist devices (LVADs) are relatively mature and have contributed to the treatment of end-stage HF. Ventricular arrhythmia (VA) is a common complication after LVAD implantation, including ventricular tachycardia and ventricular fibrillation, both of which may cause abnormal circulation. Methods: A literature search was conducted in the PubMed database, “Ventricular Arrhythmia” OR “VA” OR “Arrhythmia” OR “Ventricular Tachycardia,” OR “Ventricular Fibrillation” AND “LVAD” OR “Left Ventricular Assist Device” OR “Heart Assist Device” as either keywords or MeSH terms, the authors screened the titles and abstracts of the articles. Eventually, 12 original research articles were retrieved. Results: The 0.83 [95% CI: 0.77, 0.89] of patients were male. A whole of 53% [95% CI: 0.25, 0.81] of VA patients had a history of atrial fibrillation and 61% [95% CI: 0.52, 0.69] had a history of VA. 39% [95% CI: 0.29, 0.49] of the participants had no prior history of VA and experienced new VA following CF-LVAD implantation. Following CF-LVAD implantation, 59% [95% CI: 0.51, 0.67] of patients developed early VA (VA ≤30 days). The 30-day mortality rate of patients was 4% [95% CI: 0.01, 0.07]. And overall mortality was 28% [95% CI: 0.15, 0.41]. The reported incidence of VA after LVAD implantation is not identical in different medical centers and ranges from 20% to 60%. The mechanism of VA after LVAD implantation is summarized as primary cardiomyopathy-related, device mechanical stimulation, myocardial scarring, ventricular displacement, electrolyte regulation, and other processes. Conclusions: A preoperative VA history is considered a predictor of VA following LVAD implantation in most studies. Multiple mechanisms and factors, such as prevention of “suction events,” ablation, and implantable cardioverter defibrillator, should be considered for the prevention and treatment of postoperative VA in patients requiring long-term VAD treatment. This study provides a reference for the clinical application of LAVD and the prevention of postoperative VA after LVAD implantation. Future multicenter prospective studies with uniform patient follow-up are needed to screen for additional potential risk factors and predictors. These studies will help to define the incidence rate of VA after LAVD implantation. As a result, we provide guidance for the selection of preventive intervention.

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Section: Discussionmentioning

confidence: 99%

A Review of New-Onset Ventricular Arrhythmia after Left Ventricular Assist Device Implantation

Shi

Liu³

2022

Cardiology

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“…Future treatment approaches and strategies for ventricular arrhythmias should include cardiac sympathetic denervation. Using this method, Vlismas et al 8 recently reported promising results in LVAD‐supported patients with ventricular arrhythmias who were unresponsive to pharmacological agents, catheter ablation or ICD therapy.…”

Section: Discussionmentioning

confidence: 99%

Combined mechanical circulatory support for ventricular fibrillation in left ventricular assist device patient

et al. 2022

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Ventricular fibrillation, a life‐threatening ventricular arrhythmia, may result in pulselessness, loss of consciousness and sudden cardiac death. In this case report, we describe our experience in managing a 54‐year‐old man with HeartMate3 left ventricular assist device (LVAD) as a bridge to transplantation due to dilated non‐ischemic cardiomyopathy, presenting with incessant ventricular arrhythmia for 35 days despite multiple attempts to restore normal rhythm with external direct current cardioversion and anti‐arrhythmic medications. The patient remained stable in ventricular arrhythmia with no progression to asystole, but hemodynamic collapse due to right heart failure occurred in the third week. Combined use of two mechanical circulatory support devices (LVAD with VA ECMO) was needed to achieve haemodynamic and metabolic stability, eventually leading to successful heart transplantation in the index admission. The patient was discharged home 2 weeks after transplantation in good clinical condition.

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“… 10 Cardiac sympathetic denervation could also be a promising new therapeutic option for the management of recurrent ventricular arrhythmias. 11 Heart transplantation represents the optimal therapy for patients who experience refractory ventricular arrhythmias or VF during LVAD support. In this case, listing with a high priority status has to be considered timely if no other contraindications exist to avoid secondary organ damage.…”

Section: Discussionmentioning

confidence: 99%

Case report: incessant ventricular fibrillation in a conscious left ventricular assist device patient

Jakštaitė

Luedike

Wakili

et al. 2021

European Heart Journal - Case Reports

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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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Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmia in Continuous-Flow Left Ventricular Assist Device

Cited by 8 publications

References 10 publications

A Review of New-Onset Ventricular Arrhythmia after Left Ventricular Assist Device Implantation

A Review of New-Onset Ventricular Arrhythmia after Left Ventricular Assist Device Implantation

Combined mechanical circulatory support for ventricular fibrillation in left ventricular assist device patient

Case report: incessant ventricular fibrillation in a conscious left ventricular assist device patient

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