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

Abstract

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.

Management of incessant ventricular arrhythmias in a patient with left ventricular assist device: a case report

“…In instances of RV dysfunction or hemodynamic collapse, prompt hemodynamic support is imperative to prevent irreversible end-organ damage. There is a parallel case [ 7 ] involving a 54-year-old patient with dilated non-ischemic cardiomyopathy, sustained by LVAD (HeartMate3) as a bridging strategy for transplantation. This patient remained stable for 35 days, experiencing persistent VAs and RV failure, managed concomitantly with VA-ECMO and LVAD, culminating in heart transplantation.…”

“…The current literature reports that incidence of VAs after LVAD implantation ranges from 28–49% [ 4 – 6 ]. Ventricular arrhythmias can be well-tolerated with LVAD but if persistent, they may lead to haemodynamic compromise, right ventricular (RV) failure, and secondary organ dysfunctio [ 7 , 8 ]. The management of ventricular arrhythmias in LVAD patients remains challenging and requires close collaboration of heart failure cardiologists, arrhythmiologists, and heart transplant surgeons.…”

Catheter Ablation for Tachyarrhythmias in Left Ventricular Assist Device Recipients: Clinical Significance and Technical Tips

“…The LVAD effectively provided support for 60 min during VF with sinus rhythm; however, it was noted that AF was unable to sustain both systemic and pulmonary circulation in the presence of elevated central venous pressure [21]. This result may, in part, be influenced by right ventricular failure associated with AF; nonetheless, it underscores the significance of maintaining sinus atrial rhythm in such a specific scenario [16,22]. Further studies are warranted to better clarify the clinical implication of the presence of AF during durable LVAD supports.…”

Management of incessant Ventricular Arrhythmias in a Patient with left ventricular assist device: a case report

“…The current literature reports that incidence of VAs after LVAD implantation ranges from 28-49% [4][5][6] . Ventricular arrhythmias can be well-tolerated with LVAD but if persistent, they may lead to haemodynamic compromise, right ventricular (RV) failure, and secondary organ dysfunctio 7,8 . The management of ventricular arrhythmias in LVAD patients remains challenging and requires close collaboration of heart failure cardiologists, arrhythmiologists, and heart transplant surgeons.…”