scholarly journals The Burden of Ventricular Arrhythmias Following Left Ventricular Assist Device Implantation

2014 ◽  
Vol 3 (3) ◽  
pp. 145 ◽  
Author(s):  
Jan M Griffin ◽  
Jason N Katz ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Assist Device ◽  
Ventricular Assist ◽  
Increased Risk ◽  
Left Ventricular Assist

Few innovations in medicine have so convincingly and expeditiously improved patient outcomes more than the development of the left ventricular assist device (LVAD). Where optimal pharmacotherapy once routinely failed those with end-stage disease, the LVAD now offers considerable hope for the growing advanced heart failure population. Despite improvements in mortality, however, mechanical circulatory support is not without its limitations. Those supported with an LVAD are at increased risk of several complications, including infection, bleeding, stroke and arrhythmic events. While once considered benign, ventricular arrhythmias in the LVAD patient are being increasingly recognised for their deleterious influence on patient morbidity and quality of life. In addition, the often multifactorial aetiology to these episodes makes treatment difficult and optimal therapeutic management controversial. Novel strategies are clearly needed to better predict, prevent, and eradicate these arrhythmias in order to allow future generations of heart failure patients to reap the full benefits of LVAD implantation.

scholarly journals Evaluating the Hemodynamical Response of a Cardiovascular System under Support of a Continuous Flow Left Ventricular Assist Device via Numerical Modeling and Simulations

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Selim Bozkurt ◽  
Koray K. Safak
Keyword(s):  
Heart Failure ◽  
Cardiovascular System ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Continuous Flow ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Dilated cardiomyopathy is the most common type of the heart failure which can be characterized by impaired ventricular contractility. Mechanical circulatory support devices were introduced into practice for the heart failure patients to bridge the time between the decision to transplant and the actual transplantation which is not sufficient due to the state of donor organ supply. In this study, the hemodynamic response of a cardiovascular system that includes a dilated cardiomyopathic heart under support of a newly developed continuous flow left ventricular assist device—Heart Turcica Axial—was evaluated employing computer simulations. For the evaluation, a numerical model which describes the pressure-flow rate relations of Heart Turcica Axial, a cardiovascular system model describing the healthy and pathological hemodynamics, and a baroreflex model regulating the heart rate were used. Heart Turcica Axial was operated between 8000 rpm and 11000 rpm speeds with 1000 rpm increments for assessing the pump performance and response of the cardiovascular system. The results also give an insight about the range of the possible operating speeds of Heart Turcica Axial in a clinical application. Based on the findings, operating speed of Heart Turcica Axial should be between 10000 rpm and 11000 rpm.

Successful treatment of ventricular arrhythmic storm with percutaneous coronary intervention and catheter ablation in a patient with left ventricular assist device

2018 ◽  
Vol 41 (6) ◽  
pp. 333-336
Author(s):  
Nihat Firat Sipahi ◽  
Arash Mehdiani ◽  
Diyar Saeed ◽  
Udo Boeken ◽  
Hisaki Makimoto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Catheter Ablation ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Assist Device ◽  
Ventricular Assist ◽  
Device Implantation ◽  
Left Ventricular Assist

Introduction: Ventricular arrhythmias are common in patients with advanced heart failure, which may also persist after sufficient intensive therapy for heart failure even with a left ventricular assist device. Although most ventricular arrhythmias have no hemodynamic relevance during left ventricular assist device support, some patients suffer from right ventricular decompensation due to ventricular arrhythmias resulting in severe hemodynamic deterioration and poor clinical outcomes. Methods: We describe herein an left ventricular assist device patient with refractory ventricular arrhythmic storm early after left ventricular assist device implantation. Results: The patient was admitted to our department after stenting of left anterior descending artery with subsequent polymorphic ventricular tachycardia and cardiogenic shock with ongoing multi-organ failure. After 6 days of extracorporeal life-support, a permanent left ventricular assist device was implanted. With postoperatively ongoing tachycardias, a subtotal right coronary artery occlusion was recanalized utilizing a drug-eluting stent. On the first post-intervention day, an additional catheter ablation was successfully performed. No further ventricular tachycardias were detected during the entire hospital stay and the further postoperative course was uneventful. The patient was transferred to a physiotherapy unit to improve his daily physical activities. He is currently at home and doing well 6 months after discharge. Conclusions: Our case report demonstrates the feasibility of a successful therapeutic approach with a combination of interventional therapies such as coronary stenting and catheter ablation in a patient with persistent ventricular arrhythmias after assist device implantation.

scholarly journals Invasive Haemodynamic Assessment Before and After Left Ventricular Assist Device Implantation: A Guide to Current Practice

2021 ◽  
Vol 16 ◽  
Author(s):  
Jesus Gonzalez ◽  
Paul Callan
Keyword(s):  
Heart Failure ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Assist Device ◽  
Ventricular Assist ◽  
Right Heart Catheterisation ◽  
Left Ventricular Assist

Mechanical circulatory support for the management of advanced heart failure is a rapidly evolving field. The number of durable long-term left ventricular assist device (LVAD) implantations increases each year, either as a bridge to heart transplantation or as a stand-alone ‘destination therapy’ to improve quantity and quality of life for people with end-stage heart failure. Advances in cardiac imaging and non-invasive assessment of cardiac function have resulted in a diminished role for right heart catheterisation (RHC) in general cardiology practice; however, it remains an essential tool in the evaluation of potential LVAD recipients, and in their long-term management. In this review, the authors discuss practical aspects of performing RHC and potential complications. They describe the haemodynamic markers associated with a poor prognosis in patients with left ventricular systolic dysfunction and evaluate the measures of right ventricular (RV) function that predict risk of RV failure following LVAD implantation. They also discuss the value of RHC in the perioperative period; when monitoring for longer term complications; and in the assessment of potential left ventricular recovery.

833 Evolution of sleep disordered breathing types in heart failure

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A324-A325
Author(s):  
Pratibha Anne ◽  
Rupa Koothirezhi ◽  
Ugorji Okorie ◽  
Minh Tam Ho ◽  
Brittany Monceaux ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Central Sleep Apnea ◽  
Sleep Apnoea ◽  
Left Ventricular ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Abstract Introduction Central sleep apnea is commonly seen in patients with heart failure. Here we present a case demonstrating shifting of predominant apneic events from central to obstructive type after placement of left ventricular assist device (LVAD) in end stage heart failure patient. Report of case(s) Case Presentation: 66 year-old African American male has past medical history of chronic congestive heart failure diabetes, hypertension, paroxysmal atrial fibrillation, anemia, hypothyroidism, chronic kidney disease and sleep apnea. Prior to his LVAD placement, his left ventricular ejection fraction (EF) was <10%. Patient was diagnosed with central sleep apnea with AHI of 58 (with 92% of apneic events being central events), oxygen nadir of 74%. Subsequently, patient had LVAD placed for symptomatic heart failure and repeat polysomnogram repeated at six month demonstrated an improved AHI of 45.8 with predominantly obstructive and mixed apneic events, with only 12.5% being central events. Conclusion This case report highlights not only the improvement of the sleep apnea in CHF treated with LVAD but also shows the shift of apneic events from predominantly central to obstructive type post LVAD. Support (if any) 1. Henein MY, Westaby S, Poole-Wilson PA, Cowie MR, Simonds AK. Resolution of central sleep apnoea following implantation of a left ventricular assist device. Int J Cardiol. 2010 Feb 4;138(3):317–9. PMID: 18752859. 2. Köhnlein T, Welte T, Tan LB, Elliott MW. Central sleep apnoea syndrome in patients with chronic heart disease: a critical review of the current literature. Thorax. 2002 Jun;57(6):547–54. PMID: 12037232 3. Monda C, Scala O, Paolillo S, Savarese G, Cecere M, D’Amore C, Parente A, Musella F, Mosca S, Filardi PP. Apnee notturne e scompenso cardiaco: fisiopatologia, diagnosi e terapia [Sleep apnea and heart failure: pathophysiology, diagnosis and therapy]. G Ital Cardiol (Rome). 2010 Nov;11(11):815–22. Italian. PMID: 21348318.

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