Dual HeartMate 3 in total artificial heart configuration for incessant ventricular fibrillation: a case report

Background Ventricular arrhythmias are a major therapeutic challenge in the management of advanced heart failure, which often complicates the use of conventional mechanical circulatory support (MCS). Case summary A 46-year-old man with advanced heart failure developed refractory ventricular tachyarrhythmias. He experienced progressive haemodynamic instability, which necessitated a stepwise escalation of temporary MCS. Despite adequate ventricular unloading and acute antiarrhythmic management, his rhythm deteriorated into incessant ventricular fibrillation that lasted for 28 days. Given the low possibility of myocardial recovery and an anticipated waiting time of more than 2 months (even with urgent listing for heart transplantation in our country), the temporary MCS was transitioned to durable biventricular support using two HeartMate 3 devices in a total artificial heart configuration. This configuration eliminated arrhythmogenic and thrombogenic myocardial substrates and provided stable circulatory support. The patient resumed early active rehabilitation and received a heart transplant after 72 days of dual HeartMate 3 support without adverse events such as pump thrombosis, haemolysis, stroke, or bleeding during support. Discussion This case demonstrates that using two continuous-flow ventricular assist devices in a total artificial heart configuration may represent a viable strategy of advanced mechanical circulatory support in highly selected patients with refractory ventricular arrhythmia.