Abstract
IntroductionLeft Ventricular Assist Devices (LVAD) are becoming more common in the treatment of advanced heart failure. Patients with LVADs can present with life threatening sequelae of heart failure such as sustained VT and VF. Despite frequent documented presentations with ventricular arrhythmias in this patient population, presenting with ventricular asystole in patients with LVADs has not been previously described. We present a patient with LVAD, and without ICD, who presented in ventricular asystole. Case ReportA 67-year-old male with a history of ischemic cardiomyopathy and Heartmate III LVAD implanted one year prior to presentation as destination therapy presented to our facility complaining of three weeks of fatigue, dizziness with four days of nausea and emesis. He was noted to have an electrocardiogram (ECG) demonstrating artifact associated with the LVAD, however without discernible ventricular activity (Figure 1). Multiple ECGs and cardiac monitor tracings failed to demonstrate ventricular electrical activity, concerning for fine VF versus asystole. Transthoracic Echocardiogram (TTE) demonstrated bi-ventricular standstill. The patient was started on inotropes with Dobutamine then underwent Right Heart Catheterization (RHC). Catheter-induced ventricular potentials were repeatedly recorded, favoring asystole due to complete heart block (CHB) over fine VF. The patient underwent dual chamber ICD implant to allow ventricular pacing, which resulted in hemodynamic improvement. ConclusionsThere have been several case reports which mentioned patients surviving fatal arrhythmias with an LVAD. To our knowledge, none have described hemodynamic stability with asystole due to CHB as the presenting rhythm. The incidence of conduction disease and arrhythmia in this patient population may indicate necessity of ICD implantation prior to LVAD implant.