Departmnet of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA.
Advanced Heart Failure Center, Cardiovascular Intensive Care Unit, Medical Center, Navicent Health, Macon, GA, USA.
Am J Case Rep. 2020 Jun 20;21:e923711. doi: 10.12659/AJCR.923711.
BACKGROUND 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.
充血性心力衰竭（CHF）影响全球超过 2300 万人，美国超过 580 万人。左心室辅助装置（LVAD）的植入既可以作为晚期 CHF 患者的桥接治疗，也可以作为终末期治疗。据报道，LVAD 会引起室性心律失常。对于严重 CHF 患者，如果不进行治疗，室性心动过速和心室颤动（VF）是常见的致命性心律失常。我们报告了一例 LVAD 患者无植入式心律转复除颤器（ICD），在除颤前出现非典型症状的 VF，且持续时间未知。
一名 74 岁男性，因精神状态改变、嗜睡和言语不清 1 天，通过紧急医疗服务（EMS）被送往医院。他的既往病史包括充血性心力衰竭伴左心室辅助装置 Heart Mate II。EMS 所做的初始心电图（ECG）异常，但被认为是 LVAD 引起的伪影。在急诊中心进行的 12 导联心电图显示 VF。他需要进行电除颤。由于持续存在多器官功能衰竭，他被收入重症监护病房（ICU）进一步治疗。
在 VF 的治疗中，除颤时间至关重要。LVAD 患者可能出现 VF 并伴有非特异性症状。EMS 人员应该意识到这一点，因为这在心电图上可能表现为伪影。
