Awake ventricular fibrillation or tachycardia in LVAD patients was short-term tolerable with a median MAP of 70 mm Hg, but was associated with a 26% overall mortality rate.
Cohort (n=19)
No
LVAD patients can tolerate sustained ventricular arrhythmias short-term with maintained hemodynamics, but an awake VF/VT presentation is associated with significant in-hospital mortality (26%).
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.
Bracy et al. (Tue,) conducted a cohort in Awake ventricular fibrillation or ventricular tachycardia in LVAD patients (n=19). Awake ventricular fibrillation or tachycardia in LVAD patients was short-term tolerable with a median MAP of 70 mm Hg, but was associated with a 26% overall mortality rate.