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 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.
Busch
Mathias C
MC
Department of Internal Medicine B, University of Greifswald, Greifswald, Germany.
Haap
Michael
M
Kristen
Arnt
A
Haas
Christian S
CS
D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D004554:Electric Countershock; D004562:Electrocardiography; D006333:Heart Failure / Q000601:surgery; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D014693:Ventricular Fibrillation / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone