What is the clinical evidence from this study?

Study design: Cohort. Population: Awake ventricular fibrillation or ventricular tachycardia in LVAD patients (n=19).

August 29, 2023

Stable Ventricular Fibrillation: A Paradigm Rather Than Septal Shift?

CBConnor L BracyMedStar Washington Hospital Center PKPei-Ying KobresMedStar Washington Hospital Center MHM.J. HocksteinMedStar Washington Hospital Center

Key Result

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.

Study Design

Type

Cohort (n=19)

Multicenter

Structured PICO

Population

19 patients supported by left ventricular assist devices (LVADs) presenting to the emergency department in awake ventricular fibrillation (VF) or ventricular tachycardia (VT) between December 2015 and July 2021, out of 175 patients reviewed at a high-volume LVAD center.

Outcome

Hemodynamic tolerability (MAP, LVAD flow), clinical management, and in-hospital mortality

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%).

Abstract

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.

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