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  1. Yasad Rabady says

    Sounds like the patient had an LVAD, it’s happened a few times at my university’s hospital.

  2. Icarus says

    it must be noted that V-Fib in VAD patients is not without its complications. I am an intern at a University hospital that has a big transplant service. Sometimes depending on the degree of aortic valve opening during cardiac cycle, some output may be delivered as well. Moreover, the right ventricle does not have a VAD (Dual VAD is not available yet) and the pulmonary circulation will lose its supplier.
    Any comments on how this patient was doing despite the RV fibrillation? Cheers

    • Christina Yang says

      VF in patients with an LVAD is generally the strangest thing ever to see -- most pumps implanted at present are continuous flow VADs meaning that patients don’t often have a pulse. It is usually pretty well tolerated, although a number of these patients also have an AICD which can give them a nasty boot. For VAD patients presenting with VF, the first thing to do is go with ALS algorithms -- if the patient is conscious and the pump flows are okay (ie. maintaining a cardiac output), defibrillation is normally done as a planned procedure with AP pad placement. In a patient with VF who has lost output, emergent defibrillation can be carried out. Whatever it is that you do, you absolutely MUST contact the relevant advanced heart failure/cardiac transplant team (usually consisting of a surgeon and cardiologist) in order to alert them to the problem and allow specialist management to take place.
      Incidentally, BiVADs do exist. There have been a few purpose built BiVADs but mostly now, LVADs are being used off-label and implanted from the RV apex to the PA…

      • Christina Yang says

        The other important point to make with regards to VF or other ventricular arrhythmia in patients with VAD is that they do sometimes arise from suction (suck down of the myocardium into the inflow cannula) and this can be a potentially dangerous problem rather than the VF itself.

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