title: Sustained ventricular fibrillation in an alert patient: preserved hemodynamics with a left ventricular assist device.
abstract: Emergency medical services (EMS) encountered an alert patient with sustained ventricular fibrillation with preserved hemodynamics via a left ventricular assist device (LVAD). Multiple firings of the patient's implantable defibrillator were the only sign that this patient was experiencing the usually fatal ventricular arrhythmia. Initial attempts at rhythm conversion with amiodarone and 200-J biphasic shocks were unsuccessful. The patient was finally defibrillated to normal sinus rhythm after a 360-J biphasic shock. This case conference highlights the increasing prevalence of LVADs. These devices are used not only as a bridge to cardiac transplantation, but also as definitive therapy for patients in end-stage cardiac failure. Ventricular fibrillation has been shown to be well tolerated in patients with LVADs, and we discuss a standard of care for these patients. The occurrence of sustained ventricular fibrillation in patients with ventricular assist devices represents a challenging situation for EMS and emergency department providers and one that will be increasingly encountered in the future.
authors.affiliation: University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7594, USA.
authors.forename: Poonam
authors.initials: P
authors.lastname: Patel
authors.forename: Jefferson G
authors.initials: JG
authors.lastname: Williams
authors.forename: Jane H
authors.initials: JH
authors.lastname: Brice
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage* / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000627:therapeutic use; D017147:Defibrillators, Implantable; D004554:Electric Countershock; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000628:therapy*
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone