Answer: Surviving the storm: ventricular fibrillation in the left ventricle assist device era

This Spot the Diagnosis article refers to ‘Question: Surviving the storm: ventricular fibrillation in the left ventricle assist device era’, by G. Campos et al., https://doi.org/10.1093/ehjacc/zuae025. What would be the most appropriate next step? Urgent coronary angiography Adjust left ventricular assist device (LVAD) parameters (increase pump speed) Urgent cardiac defibrillation Intravenous amiodarone loading Ventricular arrhythmias (VAs) are common after LVAD implantation, with the main predisposing factor being VA prior to the implant.1 Many patients with a LVAD tolerate sustained VA (Figure 1) and the survival benefit of implantable cardioverter defibrillator therapies in continuous-flow LVAD patients is uncertain. There is, however, concern about a reduction in pump flow and cardiac output during sustained VAs, as well as potential adverse effects on RV function or thrombosis.2 Routine eletrocardiogram. The management of LVAD patients with VA depends on the clinical presentation of the patient. In the case of haemodynamic instability, immediate defibrillation is indicated, as it will not harm the device. In patients with no acute haemodynamic compromise, intravenous amiodarone loading and reduction in pump speed are advised. Prompt evaluation to rule out a suction event or other reversible causes, such as electrolyte disturbances, should also be done. In patients not responding to these measures, sedation and cardioversion must be performed.2 Given the clinical presentation (no chest pain) and patient history (non-ischaemic dilated cardiomyopathy), coronary artery disease as a cause of the arrhythmia seems unlikely. None declared. No new data were generated or analysed in support of this research.