Department of Internal Medicine B, University of Greifswald, Greifswald, Germany.
Ann Emerg Med. 2011 Jan;57(1):25-8. doi: 10.1016/j.annemergmed.2010.05.023. Epub 2010 Jul 31.
Optimal medical treatment, cardiac resynchronization, and the use of an implantable cardioverter defibrillator are established therapies of severe congestive heart failure. In refractory cases, left ventricular assist devices are more and more used not only as bridging to cardiac transplantation but also as destination therapy. Ventricular arrhythmias may represent a life-threatening condition and often result in clinical deterioration in patients with congestive heart failure. We report a case of asymptomatic sustained ventricular fibrillation with preserved hemodynamics caused by a nonpulsatile left ventricular assist device. Consecutive adequate but unsuccessful discharges of the implantable cardioverter defibrillator were the only sign of the usually fatal arrhythmia, prompting the patient to consult emergency services. Electrolyte supplementation and initiation of therapy with amiodarone followed by external defibrillation resulted in successful restoration of a stable cardiac rhythm after 3.5 hours.
优化的医疗、心脏再同步治疗和植入式心脏复律除颤器的使用是严重充血性心力衰竭的既定治疗方法。在难治性病例中，越来越多地使用左心室辅助装置不仅作为心脏移植的桥接治疗，而且还作为终末期治疗。室性心律失常可能是一种危及生命的情况，常导致充血性心力衰竭患者的临床恶化。我们报告了一例由非搏动性左心室辅助装置引起的无症状持续性心室颤动伴血流动力学稳定的病例。植入式心脏复律除颤器连续进行了适当但不成功的放电，这是通常致命性心律失常的唯一迹象，促使患者咨询急诊服务。电解质补充和胺碘酮治疗的启动，随后进行体外除颤，3.5 小时后成功恢复了稳定的心脏节律。
