P476 TOLERATED SUSTAINED VENTRICULAR FIBRILLATION IN LVAD RECIPIENT: THE WALKING DEAD Article Swipe
Alessandro Mauriello
,
Anna Chiara Maratea
,
Cristiano Amarelli
,
Ciro Maiello
,
Francesco S. Loffredo
,
B Liccardo
,
Paolo Golino
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1093/eurheartjsupp/suad111.538
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1093/eurheartjsupp/suad111.538
A 73–year–old man comes to the cardiac surgery clinic, due to the onset of an arrhythmic storm. In 1999, the patient was diagnosed with dilated cardiomyopathy with finding of a pathogenic mutation of the MYH7 gene by NGS panel analysis. Because of severely reduced systolic function despite OMT and left conduction delay, he underwent CRT–D implant in class IA. The patient‘s course was characterized by multiple exacerbations and a worsening course of ventricular dysfunction (EF 20%), such as to configure a picture of advanced heart failure, INTERMACS III (frequent flyer). Approximately 6 months later, the patient was admitted with signs of hypoperfusion refractory to inotrope therapy and significant congestion. In consideration of age, frailty and irreversible renal dysfunction, the patient was excluded from the transplant list. Therefore, he was a candidate for mechanical support as destination therapy, through the implantation of the Heart Mate III. At admission, the patient was monitored with evidence of ventricular fibrillation (image 1) and relative hemodynamic stability. The vital parameters reported a BP of 90/76 mmHg, FC not evaluable and SpO2 of 80%. For this reason, in anesthesiological assistance, asynchronous external defibrillation (200 J) was performed with restoration of the pacing rhythm. The monitoring of the LVAD showed a series of alerts: a reduction of the Pump Flow and phases of reduction of the Pulse Index (image 2). Event monitoring of the CRT–D revealed that the patient developed an arrhythmic storm, with appropriate but ineffective several shocks. The 8 shocks were followed by the interruption of the device therapies, but the patient, despite the ventricular fibrillation, had preserved perfusion. Medical therapy was optimized (mexiletine add–on) and CRT–D was rescheduled. Conclusions The presence of LVAD ensures a satisfactory cardiac output during arrhythmias that would lead to hemodynamic compromise. For this reason it is possible to identify patients who autonomously come to our observation in "cardiac arrest".
Related Topics
Concepts
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1093/eurheartjsupp/suad111.538
- https://academic.oup.com/eurheartjsupp/article-pdf/25/Supplement_D/D230/50379962/suad111.538.pdf
- OA Status
- bronze
- Related Works
- 10
- OpenAlex ID
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All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4377019832Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1093/eurheartjsupp/suad111.538Digital Object Identifier
- Title
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P476 TOLERATED SUSTAINED VENTRICULAR FIBRILLATION IN LVAD RECIPIENT: THE WALKING DEADWork title
- Type
-
articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2023Year of publication
- Publication date
-
2023-05-01Full publication date if available
- Authors
-
Alessandro Mauriello, Anna Chiara Maratea, Cristiano Amarelli, Ciro Maiello, Francesco S. Loffredo, B Liccardo, Paolo GolinoList of authors in order
- Landing page
-
https://doi.org/10.1093/eurheartjsupp/suad111.538Publisher landing page
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https://academic.oup.com/eurheartjsupp/article-pdf/25/Supplement_D/D230/50379962/suad111.538.pdfDirect link to full text PDF
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YesWhether a free full text is available
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bronzeOpen access status per OpenAlex
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https://academic.oup.com/eurheartjsupp/article-pdf/25/Supplement_D/D230/50379962/suad111.538.pdfDirect OA link when available
- Concepts
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Medicine, Cardiology, Defibrillation, Internal medicine, Ventricular fibrillation, Heart failure, Inotrope, Cardiac index, Hemodynamics, Cardiac outputTop concepts (fields/topics) attached by OpenAlex
- Cited by
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0Total citation count in OpenAlex
- Related works (count)
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10Other works algorithmically related by OpenAlex
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