Unusual clinical course
Harry O. Eyituoyo, Rieta N. Aben, Nkechi C. Arinze, Dat Phat Vu, Erskine A. James
Departmnet of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
Am J Case Rep 2020; 21:e923711
Available online: 2020-05-06
Congestive heart failure (CHF) affects over 23 million individuals worldwide and over 5.8 million individuals in the United States. Left ventricular assist device (LVAD) implantation is used as both a bridging and destination therapy for patients with advanced CHF. LVADs are reported to cause ventricular arrhythmias. Ventricular tachycardia and ventricular fibrillation (VF) are common fatal arrhythmias in patients with severe CHF if left untreated. We report a case in which a patient with an LVAD without an implantable cardioverter device (ICD) developed VF with non-classical symptoms with an unknown duration prior to defibrillation.
CASE REPORT: A 74-year old man was brought to the hospital via Emergency Medical Services (EMS) with a 1-day history of altered mental status, somnolence, and slurred speech. His past medical history was significant for CHF with LVAD Heart Mate II. An initial electrocardiogram (ECG) done by EMS was abnormal but was presumed to be an artifact secondary to LVAD. A 12-lead ECG done in the Emergency Center revealed VF. He required electrical defibrillation. Due to ongoing multiple organ failure, he was admitted to the Intensive Care Unit (ICU) for further care.
CONCLUSIONS: In the management of VF, the time to defibrillation is of paramount importance. LVAD patients could be in VF and present with non-specific symptoms. EMS personnel should be aware of this, as it can appear to be an artifact on ECG.
Keywords: Arrhythmias, Cardiac, Heart-Assist Devices, Ventricular Fibrillation, Heart Failure