Abstract
BackgroundContinuous-flow left ventricular assist devices (LVADs) improve survival and morbidity in patients with stage D heart failure. Management of LVADs for longer durations is necessary in some clinical settings, and a better understanding of the hemodynamics of patients using LVADs is warranted. Arrhythmia, including atrial (AA) and ventricular (VAs) arrhythmias, is a modifying factor of hemodynamics that is highly prevalent among patients with LVADs. However, the clinical impact of arrhythmias in various clinical settings in patients with LVAD, in which the hemodynamic load is likely to present as worsening of right heart failure, remains to be completely elucidated.Case presentationWe describe the case of a patient under sustained ventricular fibrillation for extraordinarily long duration who was stabilized using LVAD support and in whom newly developed atrial fibrillation led to a significant worsening of right heart failure while using an LVAD.ConclusionThis case demonstrates the substantial clinical impact of AAs in the management of right heart failure using an LVAD.
Highlights
Continuous-flow left ventricular assist devices (LVADs) improve survival and morbidity in patients with stage D heart failure
We report the case of a patient with sustained ventricular fibrillation (VF) for 3 years under LVAD support who had worsening of heart failure with new onset of atrial fibrillation (AF)
He had remained sustained VF, the recovery of sinus rhythm finely corresponded to the improvement of heart failure and the level of his total bilirubin decreased to 1.2 mg/dl. It intensely corroborated the contribution of persistent AF on the worsening of right heart failure. Both AAs and ventricular arrhythmias (VAs) are common in patients with severe heart failure under LVAD support; VAs have been reported in about 20% of LVADs patients [3], with some of them being refractory to various therapies
Summary
Continuous-flow left ventricular assist devices (LVADs) improve survival and morbidity in patients with stage D heart failure. Conclusion: This case demonstrates the substantial clinical impact of AAs in the management of right heart failure using an LVAD. * Correspondence: amiyae-tky@umin.ac.jp 1Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo 113-8655, Japan Full list of author information is available at the end of the article the hemodynamic characteristics of these arrhythmias under LVADs have not been fully elucidated.
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