Malignant ventricular arrhythmias are well tolerated in patients receiving long-term left ventricular assist devices

Mehmet C. Oz, Eric A. Rose, James Slater, Johannes J. Kuiper, Katharine A. Catanese, Howard R. Levin

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

Objectives. We sought to quantitate the incidence of malignant ventricular arrhythmias and to identify subsequent hemodynamic changes and untoward events in patients who have received an implantable left ventricular circulatory assist device as an extended bridge to heart transplantation. Background. Implantable long-term mechanical circulatory assist devices have been used clinically with increasing frequency and success for the past 4 years. Previous investigators have suggested that patients with malignant ventricular arrhythmias receiving a left ventricular assist device will require both left and right ventricular assistance to maintain vital organ perfusion. Methods. We reviewed our 4-year experience with 21 patients who underwent implantation of a left ventricular assist device. Device flows and mean arterial pressure were used to assess systemic perfusion; central venous pressure provided a gauge of right ventricular function. Charts were screened for evidence of end-organ injury resulting from malignant ventricular arrhythmias. Results. Malignant ventricular arrhythmias occurred in 4 patients (19%) before device placement and in 9 patients (43%) during device support. The latter nine patients formed the final study group; their arrhythmias occurred 0 to 186 days after device implantation and had a duration of 10 min to 12 days. The patients reported weakness or palpitation; however, none reported syncope or dyspnea. Mean arterial pressure and central venous pressure were insiganificantly changed by the arrhythmias. Device flow decreased by 1.4 ± 0.6 liters/min (p < 0.05) at the onset of the arrhythmias but returned to normal after cardioversion. No thromboembolic events or significant end-organ dysfunction occurred. Conclusion. Absence of right ventricular contraction during malignant ventricular arrhythmias is well tolerated in recipients of a left ventricular assist device. The diagnosis of malignant arrhythmia should be suspected if an unexplained decrease in left ventricular assist device flow occurs. Early electrical cardioversion is warranted to avoid both thrombus formation in the native heart and right ventricular myocardial injury from prolonged fibrillation.

Original languageEnglish (US)
Pages (from-to)1688-1691
Number of pages4
JournalJournal of the American College of Cardiology
Volume24
Issue number7
DOIs
StatePublished - Jan 1 1994

Fingerprint

Heart-Assist Devices
Cardiac Arrhythmias
Equipment and Supplies
Electric Countershock
Central Venous Pressure
Arterial Pressure
Perfusion
Right Ventricular Function
Wounds and Injuries
Syncope
Heart Transplantation
Dyspnea
Thrombosis
Hemodynamics
Research Personnel
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Oz, Mehmet C. ; Rose, Eric A. ; Slater, James ; Kuiper, Johannes J. ; Catanese, Katharine A. ; Levin, Howard R. / Malignant ventricular arrhythmias are well tolerated in patients receiving long-term left ventricular assist devices. In: Journal of the American College of Cardiology. 1994 ; Vol. 24, No. 7. pp. 1688-1691.
@article{4379d01e4d084e0395c9a64f1c39d2d6,
title = "Malignant ventricular arrhythmias are well tolerated in patients receiving long-term left ventricular assist devices",
abstract = "Objectives. We sought to quantitate the incidence of malignant ventricular arrhythmias and to identify subsequent hemodynamic changes and untoward events in patients who have received an implantable left ventricular circulatory assist device as an extended bridge to heart transplantation. Background. Implantable long-term mechanical circulatory assist devices have been used clinically with increasing frequency and success for the past 4 years. Previous investigators have suggested that patients with malignant ventricular arrhythmias receiving a left ventricular assist device will require both left and right ventricular assistance to maintain vital organ perfusion. Methods. We reviewed our 4-year experience with 21 patients who underwent implantation of a left ventricular assist device. Device flows and mean arterial pressure were used to assess systemic perfusion; central venous pressure provided a gauge of right ventricular function. Charts were screened for evidence of end-organ injury resulting from malignant ventricular arrhythmias. Results. Malignant ventricular arrhythmias occurred in 4 patients (19{\%}) before device placement and in 9 patients (43{\%}) during device support. The latter nine patients formed the final study group; their arrhythmias occurred 0 to 186 days after device implantation and had a duration of 10 min to 12 days. The patients reported weakness or palpitation; however, none reported syncope or dyspnea. Mean arterial pressure and central venous pressure were insiganificantly changed by the arrhythmias. Device flow decreased by 1.4 ± 0.6 liters/min (p < 0.05) at the onset of the arrhythmias but returned to normal after cardioversion. No thromboembolic events or significant end-organ dysfunction occurred. Conclusion. Absence of right ventricular contraction during malignant ventricular arrhythmias is well tolerated in recipients of a left ventricular assist device. The diagnosis of malignant arrhythmia should be suspected if an unexplained decrease in left ventricular assist device flow occurs. Early electrical cardioversion is warranted to avoid both thrombus formation in the native heart and right ventricular myocardial injury from prolonged fibrillation.",
author = "Oz, {Mehmet C.} and Rose, {Eric A.} and James Slater and Kuiper, {Johannes J.} and Catanese, {Katharine A.} and Levin, {Howard R.}",
year = "1994",
month = "1",
day = "1",
doi = "10.1016/0735-1097(94)90175-9",
language = "English (US)",
volume = "24",
pages = "1688--1691",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "7",

}

Malignant ventricular arrhythmias are well tolerated in patients receiving long-term left ventricular assist devices. / Oz, Mehmet C.; Rose, Eric A.; Slater, James; Kuiper, Johannes J.; Catanese, Katharine A.; Levin, Howard R.

In: Journal of the American College of Cardiology, Vol. 24, No. 7, 01.01.1994, p. 1688-1691.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Malignant ventricular arrhythmias are well tolerated in patients receiving long-term left ventricular assist devices

AU - Oz, Mehmet C.

AU - Rose, Eric A.

AU - Slater, James

AU - Kuiper, Johannes J.

AU - Catanese, Katharine A.

AU - Levin, Howard R.

PY - 1994/1/1

Y1 - 1994/1/1

N2 - Objectives. We sought to quantitate the incidence of malignant ventricular arrhythmias and to identify subsequent hemodynamic changes and untoward events in patients who have received an implantable left ventricular circulatory assist device as an extended bridge to heart transplantation. Background. Implantable long-term mechanical circulatory assist devices have been used clinically with increasing frequency and success for the past 4 years. Previous investigators have suggested that patients with malignant ventricular arrhythmias receiving a left ventricular assist device will require both left and right ventricular assistance to maintain vital organ perfusion. Methods. We reviewed our 4-year experience with 21 patients who underwent implantation of a left ventricular assist device. Device flows and mean arterial pressure were used to assess systemic perfusion; central venous pressure provided a gauge of right ventricular function. Charts were screened for evidence of end-organ injury resulting from malignant ventricular arrhythmias. Results. Malignant ventricular arrhythmias occurred in 4 patients (19%) before device placement and in 9 patients (43%) during device support. The latter nine patients formed the final study group; their arrhythmias occurred 0 to 186 days after device implantation and had a duration of 10 min to 12 days. The patients reported weakness or palpitation; however, none reported syncope or dyspnea. Mean arterial pressure and central venous pressure were insiganificantly changed by the arrhythmias. Device flow decreased by 1.4 ± 0.6 liters/min (p < 0.05) at the onset of the arrhythmias but returned to normal after cardioversion. No thromboembolic events or significant end-organ dysfunction occurred. Conclusion. Absence of right ventricular contraction during malignant ventricular arrhythmias is well tolerated in recipients of a left ventricular assist device. The diagnosis of malignant arrhythmia should be suspected if an unexplained decrease in left ventricular assist device flow occurs. Early electrical cardioversion is warranted to avoid both thrombus formation in the native heart and right ventricular myocardial injury from prolonged fibrillation.

AB - Objectives. We sought to quantitate the incidence of malignant ventricular arrhythmias and to identify subsequent hemodynamic changes and untoward events in patients who have received an implantable left ventricular circulatory assist device as an extended bridge to heart transplantation. Background. Implantable long-term mechanical circulatory assist devices have been used clinically with increasing frequency and success for the past 4 years. Previous investigators have suggested that patients with malignant ventricular arrhythmias receiving a left ventricular assist device will require both left and right ventricular assistance to maintain vital organ perfusion. Methods. We reviewed our 4-year experience with 21 patients who underwent implantation of a left ventricular assist device. Device flows and mean arterial pressure were used to assess systemic perfusion; central venous pressure provided a gauge of right ventricular function. Charts were screened for evidence of end-organ injury resulting from malignant ventricular arrhythmias. Results. Malignant ventricular arrhythmias occurred in 4 patients (19%) before device placement and in 9 patients (43%) during device support. The latter nine patients formed the final study group; their arrhythmias occurred 0 to 186 days after device implantation and had a duration of 10 min to 12 days. The patients reported weakness or palpitation; however, none reported syncope or dyspnea. Mean arterial pressure and central venous pressure were insiganificantly changed by the arrhythmias. Device flow decreased by 1.4 ± 0.6 liters/min (p < 0.05) at the onset of the arrhythmias but returned to normal after cardioversion. No thromboembolic events or significant end-organ dysfunction occurred. Conclusion. Absence of right ventricular contraction during malignant ventricular arrhythmias is well tolerated in recipients of a left ventricular assist device. The diagnosis of malignant arrhythmia should be suspected if an unexplained decrease in left ventricular assist device flow occurs. Early electrical cardioversion is warranted to avoid both thrombus formation in the native heart and right ventricular myocardial injury from prolonged fibrillation.

UR - http://www.scopus.com/inward/record.url?scp=0028035002&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028035002&partnerID=8YFLogxK

U2 - 10.1016/0735-1097(94)90175-9

DO - 10.1016/0735-1097(94)90175-9

M3 - Article

VL - 24

SP - 1688

EP - 1691

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 7

ER -