Background
Continuous-Flow Left Ventricular Assist Devices (CF-LVAD) provide circulatory support to patients with advanced heart failure. These devices are traditionally used as a temporary bridge to recovery, bridge to cardiac transplantation, or as destination therapy (DT). Compared to medical management alone, LVADs improve survival1-3and quality of life4,5 for patients with severe heart failure. The incidence of ventricular arrhythmias in patients with CF-LVADs are relatively high and range anywhere from 22-59%.6 Sustained ventricular tachycardia and ventricular fibrillation are life-threatening arrhythmias which remain highly prevalent in patients with advanced heart failure.7 In particular, ventricular arrhythmias may impair hemodynamic support provided by CF-LVADs and lead to greater frequency in hospitalizations, antiarrhythmic therapies, external defibrillations, and urgent need for heart transplantation.13,14
We report a case in which a patient with a CF-LVAD and an implantable cardioverter defibrillator (ICD) at end of life (EOL) presented with asymptomatic low-flow alarms and was found to have ventricular fibrillation of unknown duration yet demonstrated organized contractility on echocardiography.