Malignant ventricular arrhythmias are well tolerated in patients receiving long-term left ventricular assist devices

Abstract

Absence of right ventricular contraction during malignant ventricular arrhythmias is well tolerated in recipients of a left ventricular assist device. The diagnosis of malignant arrhythmia should be suspected if an unexplained decrease in left ventricular assist device flow occurs. Early electrical cardioversion is warranted to avoid both thrombus formation in the native heart and right ventricular myocardial injury from prolonged fibrillation.

Ventricular Arrhythmias After Left Ventricular Assist Device

“…Patients supported by LVADs may tolerate VA with minimal symptoms and stable hemodynamics because of the LVAD's ability to maintain cardiac output independent of heart rate and atrioventricular synchrony. 21,[23][24][25][26] However, some patients with LVAD can experience right heart failure, hemodynamic deterioration, ICD shocks, and even cardiac arrest with VA caused by impaired right ventricular filling leading to inadequate LVAD flows. Uncontrollable VA can be an indication for heart transplantation, bi-VAD, or total artificial heart.…”

Treatment of Ventricular Arrhythmias in Patients Undergoing LVAD Therapy

“…Pulmonary perfusion was maintained even during rapid ventricular arrhythmias and cardiac arrest was well tolerated without syncope. Thus, delayed termination of ventricular fibrillation or flutter was reported to be safe and feasible in this setting (Oz et al, 1994). In 1997, the first case report documenting benefit from an implantable cardioverter-defibrillator (ICD) in a patient on LVAD support was published in a 51 year-old male who underwent LVAD implantation for refractory heart failure after having received an ICD five years earlier (Skinner et al, 1997).…”

Is there a need for an implantable cardioverter defibrillator in patients with left ventricular assist devices? Time for MADIT-VAD!

“…Hemodynamic compromise with VTAs in LVAD recipients might be dependent on right ventricular (RV) function, elevated pulmonary pressure, and PVR [12]. As such, LVAD recipients with sustained VTAs might be predisposed to RV failure, although the incidence and clinical relevance of RV failure induced by VTAs in this cohort is not well characterized [13]. In addition, sustained VTAs in LVAD patients are associated with an increased risk of mortality.…”