Oz M C, Rose E A, Slater J, Kuiper J J, Catanese K A, Levin H R
Division of Cardiac Surgery, College of Physicians and Surgeons, Columbia University, New York, New York.
J Am Coll Cardiol. 1994 Dec;24(7):1688-91. doi: 10.1016/0735-1097(94)90175-9.
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.
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.
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.
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 insignificantly 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.
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.
我们试图对接受植入式左心室循环辅助装置作为心脏移植过渡治疗的患者发生恶性室性心律失常的发生率进行量化，并确定随后的血流动力学变化和不良事件。
在过去4年中，植入式长期机械循环辅助装置在临床上的使用频率和成功率不断提高。先前的研究表明，患有恶性室性心律失常的患者接受左心室辅助装置时，需要左、右心室同时辅助以维持重要器官的灌注。
我们回顾了21例接受左心室辅助装置植入手术患者的4年治疗经验。通过装置流量和平均动脉压评估全身灌注；中心静脉压作为右心室功能的指标。筛查病历以寻找恶性室性心律失常导致终末器官损伤的证据。
4例患者（19%）在装置植入前发生恶性室性心律失常，9例患者（43%）在装置支持期间发生。后9例患者组成最终研究组；他们的心律失常发生在装置植入后0至186天之间，持续时间为10分钟至12天。患者报告有虚弱或心悸症状；然而，无人报告晕厥或呼吸困难。心律失常对平均动脉压和中心静脉压的影响不显著。心律失常发作时，装置流量下降1.4±0.6升/分钟（p<0.05），但在心律转复后恢复正常。未发生血栓栓塞事件或严重的终末器官功能障碍。
左心室辅助装置接受者在恶性室性心律失常期间右心室无收缩可被良好耐受。如果左心室辅助装置流量出现无法解释的下降，应怀疑发生恶性心律失常。早期进行电复律有助于避免心脏内血栓形成以及因长时间颤动导致的右心室心肌损伤。
