Background
Continuous-Flow Left Ventricular Assist Devices (CF-LVAD) provide
circulatory support to patients with advanced heart failure. These
devices are traditionally used as a temporary bridge to recovery, bridge
to cardiac transplantation, or as destination therapy (DT). Compared to
medical management alone, LVADs improve survival1-3and quality of life4,5 for patients with severe heart
failure. The incidence of ventricular arrhythmias in patients with
CF-LVADs are relatively high and range anywhere from
22-59%.6 Sustained ventricular tachycardia and
ventricular fibrillation are life-threatening arrhythmias which remain
highly prevalent in patients with advanced heart
failure.7 In particular, ventricular arrhythmias may
impair hemodynamic support provided by CF-LVADs and lead to greater
frequency in hospitalizations, antiarrhythmic therapies, external
defibrillations, and urgent need for heart
transplantation.13,14
We report a case in which a patient with a CF-LVAD and an implantable
cardioverter defibrillator (ICD) at end of life (EOL) presented with
asymptomatic low-flow alarms and was found to have ventricular
fibrillation of unknown duration yet demonstrated organized
contractility on echocardiography.