Stable Ventricular Fibrillation: A Paradigm Rather Than Septal Shift?
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 09 2023
01 09 2023
Historique:
medline:
1
9
2023
pubmed:
31
8
2023
entrez:
31
8
2023
Statut:
ppublish
Résumé
Awake patients in ventricular fibrillation is a phenomenon limited to patients who are mechanically supported. We describe a cohort of patients supported by left ventricular assist devices (LVADs) presenting to the emergency department (ED) at a high-volume LVAD center while in awake ventricular fibrillation (VF)/ventricular tachycardia (VT). Among 175 patients reviewed, a total of 19 LVAD patients presented to the ED in awake VF/VT between December 2015 and July 2021. On ED presentation, patients maintained a median mean arterial blood pressure (MAP) of 70 mm Hg with a mean LVAD flow of 3.77 L/minute. ED management included cardioversion in the majority of cases: 58% were defibrillated once, 21% were defibrillated multiple times, 68% received amiodarone, and 21% received lidocaine. Inpatient management included defibrillation, ablation, and antiarrhythmic initiation in 37%, 11%, and 84% of cases, respectively. In total, five patients (26%) died with one death attributed to recurrent VT. Our findings support the short-term tolerability of sustained ventricular arrhythmias in LVAD patients, as evidenced by the maintained MAPs and mental status. Clinical teams, however, should be aware of the potential harbinger for in-hospital mortality heralded by an awake VF/VT presentation.
Identifiants
pubmed: 37651097
doi: 10.1097/MAT.0000000000001984
pii: 00002480-202309000-00004
doi:
Substances chimiques
Amiodarone
N3RQ532IUT
Lidocaine
98PI200987
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
835-840Informations de copyright
Copyright © ASAIO 2023.
Déclaration de conflit d'intérêts
Disclosure: The authors have no conflicts of interest to report.
Références
Tsao CW, Aday AW, Almarzooq ZI, et al.: Heart Disease and Stroke Statistics-2022 update: A report from the American Heart Association. Circulation. 145: e153–e639, 2022.
Sanaiha Y, Downey P, Lyons R, Nsair A, Shemin RJ, Benharash P: Trends in utilization, mortality, and resource use after implantation of left ventricular assist devices in the United States. J Thorac Cardiovasc Surg. 161: 2083–2091.e4, 2021.
Trachtenberg BH, Estep JD: Roads, maps, and destinations: The journey of left ventricular assist device implantation in ambulatory patients with advanced heart failure. Curr Cardiol Rep. 18: 132, 2016.
Kormos RL, Cowger J, Pagani FD, et al.: The Society of Thoracic Surgeons Intermacs database annual report: Evolving indications, outcomes, and scientific partnerships. J Heart Lung Transplant. 38: 114–126, 2019.
Gopinathannair R, Cornwell WK, Dukes JW, et al.: Device therapy and arrhythmia management in left ventricular assist device recipients: A scientific statement from the American Heart Association. Circulation. 139: e967–e989, 2019.
Mott IH, Poulsen SH, Løgstrup BB: Awake and aware with ongoing ventricular fibrillation during LVAD treatment: Is it possible? BMJ Case Rep. 13: e234527, 2020.
Gordon JS, Maynes EJ, Choi JH, et al.: Ventricular arrhythmias following continuous-flow left ventricular assist device implantation: A systematic review. Artif Organs. 44: E313–E325, 2020.
Kadado AJ, Akar JG, Hummel JP: Arrhythmias after left ventricular assist device implantation: Incidence and management. Trends Cardiovasc Med. 28: 41–50, 2018.
Brenyo A, Rao M, Koneru S, et al.: Risk of mortality for ventricular arrhythmia in ambulatory LVAD patients. J Cardiovasc Electrophysiol. 23: 515–520, 2012.
Garan AR, Yuzefpolskaya M, Colombo PC, et al.: Ventricular arrhythmias and implantable cardioverter-defibrillator therapy in patients with continuous-flow left ventricular assist devices: Need for primary prevention? J Am Coll Cardiol. 61: 2542–2550, 2013.
Yap SC, Ramjankhan F, Muslem R, et al.: Ventricular arrhythmias in patients with a continuous-flow left ventricular assist device. J Am Coll Cardiol. 68: 323–325, 2016.