Organized cardiac activity in an awake LVAD patient during ventricular fibrillation

Ablation therapy for ventricular arrhythmias in patients with LVAD: Multiple faces of an electrophysiological challenge

Left ventricular assist device implantation is a recognized treatment option for patients with advanced heart failure refractory to medical therapy and can be used both as bridge to transplantation and as destination therapy. The risk of ventricular arrhythmias is common after left ventricular assist device implantation and is influenced by pre-, peri and post-operative determinants. The management of ventricular arrhythmias can be a challenge when they become refractory to medication or to device therapy and their impact on prognosis can be detrimental despite the mechanical support. In this setting, catheter ablation is being increasingly recognized as a feasible option for patients in which standard therapeutic strategies fail, but also with preventive purpose. Catheter ablation is being increasingly considered for the management of ventricular arrhythmias in patients with left ventricular assist device despite complex clinical and technical peculiarities due to the characteristics of the mechanical support. Much conflicting data exist regarding the predictors of success of the procedure and the rate of recurrence. In this review we discuss the latest evidences regarding catheter ablation of ventricular arrhythmias in this subset of patients, focusing on clinical characteristics, arrhythmia etiology, technical aspects and postprocedural features which must be considered by the electrophysiologist.

Asymptomatic ventricular fibrillation in continuous flow left-ventricular assist device

Left ventricular assist devices (LVADs) have increased survival for heart failure patients. Individuals with LVADs are a growing patient population with frequent complications and Emergency Department (ED) visits. A 50-year-old female presented to the ED due to a low flow alarm on her LVAD. Upon arrival in the ED she was noted to be in ventricular fibrillation. She was defibrillated with restoration to normal sinus rhythm and was started on amiodarone. An implantable cardiac defibrillator was placed during hospital admission. Amiodarone was continued as an outpatient. Patients with continuous flow LVADs can be in dysrhythmias including ventricular tachycardia and ventricular fibrillation and remain relatively asymptomatic. We present a rare case of a patient with an LVAD and ventricular fibrillation who was completely asymptomatic in the ED.

Ventricular Fibrillation 7 Years After Left Ventricular Assist Device Implantation

Patient: Male, 74-year-old

Final Diagnosis: Ventricular fibrillation

Symptoms: Altered mental status • slurred speech • somnolence

Medication:—

Clinical Procedure: Left ventricular assist device placement

Specialty: Cardiology • Critical Care Medicine • General and Internal Medicine