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Tolerance Of Sustained Ventricular Fibrillation With Continuous-Flow Left Ventricular Assist Device Support
*Andrew C W Baldwin1,2, *Courtney J Gemmato3, *Steve K Singh2,3, *William E Cohn2,3, *Hari R Mallidi2,3, *O H Frazier2,3
1Yale School of Medicine, New Haven, CT;2Texas Heart Institute, Houston, TX;3Baylor College of Medicine, Houston, TX

Objective: The widespread adoption of continuous-flow left ventricular assist devices (CF LVADs) in the field of mechanical circulatory support (MCS) has demonstrated that a clinical “pulse” is not required for long-term hemodynamic support. We present the incidental discovery of ventricular fibrillation (VF) in alert, hemodynamically stable patients supported only by a CF device.
Design: Case series.
Setting: Academic tertiary care center.
Patients: Seven clinically stable patients (5 men, 2 women; average age =45 years, range =21-65 years) supported by CF LVADs were found to be in VF. Patients were supported by the HeartMate II (n=5 ; Thoratec Corp.; Pleasanton, CA), Jarvik 2000 (n=1; Jarvik Heart, Inc.; New York, NY), and the TandemHeart pVAD (n=1; CardiacAssist, Inc.; Pittsburgh, PA). VF was incidentally diagnosed in 3 patients during routine outpatient follow-up, while the remainder were awaiting discharge.
Interventions: n/a
Main Outcome Measure: VF was confirmed through electrocardiogram and echocardiographic testing.
Results: The average duration of MCS prior to the event was 258±407 days (range 5-864 days). Six of the patients were conscious and ambulatory at the time of the arrhythmia, while the remaining patient was sedated but arousable. 3 patients reported symptoms—primarily consisting of fatigue, nausea, and dyspnea on exertion. Serum chemistries drawn immediately after diagnosis failed to demonstrate evidence of end-organ dysfunction. One patient suffered a hemorrhagic stroke the following year, while 2 died following eventual transplantation. The remaining 4 patients are alive and well, 2 of whom were ultimately explanted.
Conclusions: The ability to maintain prolonged hemodynamic stability and end-organ perfusion without functional contribution from the native heart demonstrates the physiologic viability of the continuous-flow total artificial heart.


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