Asymptomatic Sustained Ventricular Fibrillation in a Patient With Left Ventricular Assist Device

Optimal medical treatment, cardiac resynchronization, and the use of an implantable cardioverter defibrillator are established therapies of severe congestive heart failure. In refractory cases, left ventricular assist devices are more and more used not only as bridging to cardiac transplantation but...

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Bibliographic Details
Published in:Annals of emergency medicine 2011-01, Vol.57 (1), p.25-28
Main Authors: Busch, Mathias C., MD, Haap, Michael, MD, Kristen, Arnt, MD, Haas, Christian S., MD
Format: Article
Language:English
Subjects:
Aged
Amiodarone - therapeutic use
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anti-Arrhythmia Agents - therapeutic use
Biological and medical sciences
Blood Pressure - drug effects
Electric Countershock
Electrocardiography
Emergency
Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
Heart Failure - surgery
Heart-Assist Devices - adverse effects
Humans
Intensive care medicine
Male
Medical sciences
Ventricular Fibrillation - drug therapy
Ventricular Fibrillation - etiology
Ventricular Fibrillation - physiopathology
Ventricular Fibrillation - therapy
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Summary:Optimal medical treatment, cardiac resynchronization, and the use of an implantable cardioverter defibrillator are established therapies of severe congestive heart failure. In refractory cases, left ventricular assist devices are more and more used not only as bridging to cardiac transplantation but also as destination therapy. Ventricular arrhythmias may represent a life-threatening condition and often result in clinical deterioration in patients with congestive heart failure. We report a case of asymptomatic sustained ventricular fibrillation with preserved hemodynamics caused by a nonpulsatile left ventricular assist device. Consecutive adequate but unsuccessful discharges of the implantable cardioverter defibrillator were the only sign of the usually fatal arrhythmia, prompting the patient to consult emergency services. Electrolyte supplementation and initiation of therapy with amiodarone followed by external defibrillation resulted in successful restoration of a stable cardiac rhythm after 3.5 hours.
ISSN:0196-0644
1097-6760
DOI:10.1016/j.annemergmed.2010.05.023