title: Prolonged asystole in a patient with an isolated left ventricular assist device.
abstract: Left ventricular assist devices (LVADs) are well established in the management of end-stage heart failure as either destination therapy, a bridge prior to cardiac transplantation or during myocardial recovery. Despite LVADs requiring adequate left ventricular preload to effectively augment systemic circulation, there have been rare cases of patients with LVADs surviving sustained, normally fatal arrhythmias, such as ventricular fibrillation and asystole. Whilst current reports describe an LVAD patient surviving 15 days with such an arrhythmia, we describe the case of a patient with an LVAD surviving 104 days of asystole via a Fontan mechanism of circulation, which we believe is the longest known survival of a sustained fatal arrhythmia. This case highlights the physiology of circulations supported by LVADs and the unique challenges that may arise in managing ambulant LVAD patients, such as predicting prognosis. Given the increasing use of LVADs to treat end-stage heart failure, these issues are likely to become more frequently encountered in the future.
authors.affiliation: Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
authors.forename: Wasim
authors.initials: W
authors.lastname: Javed
authors.affiliation: The Transplant Centre, Wythenshawe Hospital, Manchester, UK.
authors.forename: Parminder S
authors.initials: PS
authors.lastname: Chaggar
authors.affiliation: The Transplant Centre, Wythenshawe Hospital, Manchester, UK.
authors.forename: Rajamiyer
authors.initials: R
authors.lastname: Venkateswaran
authors.affiliation: The Transplant Centre, Wythenshawe Hospital, Manchester, UK.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Shaw
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D002316:Cardiotonic Agents / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology*; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D020105:Milrinone / Q000627:therapeutic use; D017741:Survivors; D013997:Time Factors; D016278:Ventricular Function, Right / Q000502:physiology
chemical_list: D002316:Cardiotonic Agents; D020105:Milrinone
keywords: Fontan circulation; asystole; heart failure; left ventricular assist device