Z Kardiol 94: Suppl 2 (2005)

Severe Ventricular Tachyarrhythmia during long-term Mechanical Circulatory Support with a Left Ventricular Assist Device
ChrD. Etz1, H. Welp2, A. Hoffmeier2, H. H. Scheld2, C. Schmid2, G. Drees2
1Universitätsklinikum Münster, Klinik und Poliklinik fuer Thorax-, Herz- und Gefässchirurgie, Münster, BusinessLogic.Land; 2Klinik u. Polikl. f. Herz-, Thorax- u. Gefäßchirurgie, Universitätsklinikum Münster, Münster;

Left ventricular support as bridge-to-transplant, bridge-to-recovery or destination therapy in patients suffering from end-stage congestive heart failure is increasingly available. Various underlying heart diseases are associated with malignant ventricular arrhythmia, which may affect pump output and right ventricular function.

Patients and Methods Twelve patients of 170 patients, 33 - 67 years old, with severe ventricular arrhythmia during pulsatile (Novacor = 4, Heartmate = 1) or non-pulsatile (Incor Berlin Heart = 4, Micromed DeBakey = 3) mechanical left ventricular assistance were included into the retrospective analysis. Underlying heart disease was end-stage ischemic heart failure (n = 8), dilative cardiomyopathy (n = 3) and myocarditis (n = 1). All patients were listed for heart transplantation. Three patients had an ICD implantation before LVAD implantation.  

Results Eleven patients presented with multiple episodes of malignant ventricular tachyarrhythmia lasting from a minute to more than 2 hours (overall incidence 6 %). Six patients underwent external (n = 4) or internal (n = 3) defibrillation of ventricular fibrillation, 3 patients required conversion of sustained ventricular tachyarrhythmia. Two of these patients underwent ICD implantation during LVAD support. Recurrent non-sustained ventricular tachycardias occurred in one patient. Another patient presented ongoing ventricular fibrillation, which did not clinically compromise his cardiopulmonary function and was therefore tolerated until spontaneous conversion after 11 days following amiodarone treatment. No patient developed severe right heart failure as a consequence of recurrent ventricular tachyarrhythmia.

Conclusion Severe ventricular tachyarrhythmias is no contraindication for LVAD implantation as bridge-to-transplant in end-stage heart failure patients. Left ventricular assistance by pulsatile and non-pulsatile devices did not prevent tachyarrhythmias in patients suffering from end-stage heart disease. Severe ventricular tachyarrhythmias do not necessarily require implantation of an ICD implantation.